Archief Roodbont

Among patients with recent stroke or transient ischemic attack (TIA), combined therapy with clopidogrel plus aspirin has not been proven better than aspirin alone. But what about dipyridamole plus aspirin? A large trial published in 1996 suggested that this combination was more effective than aspirin alone, but other trials have produced conflicting findings. In the new ESPRIT trial, researchers randomized more than 2700 patients with recent stroke or TIA to receive either aspirin plus dipyridamole (200 mg twice daily) or aspirin alone. No placebo was used. During an average follow-up of 3.5 years, significantly fewer patients assigned to combination therapy than to aspirin alone experienced vascular death, nonfatal stroke, MI, or major bleeding (13% vs. 16%). A meta-analysis of this and five similar dipyridamole-aspirin studies showed an 18% relative risk reduction with combination therapy compared to aspirin alone (Journal Watch Jun 9 2006).

Clopidogrel appears to be a useful adjunct to aspirin therapy in patients with acute coronary ischemia and patients who have undergone percutaneous coronary intervention, but it should not be used with aspirin in other patients at cardiovascular risk. For patients who have had strokes or TIAs, aspirin plus dipyridamole may be the preventive treatment of choice.

— Bruce Soloway, MD

Published in Journal Watch General Medicine December 28, 2006

# posted by roodbont @ 2:33 PM