Drug May Aid Aspirin After Ministroke
Study: Aspirin Plus Antiplatelet Drug Beat Aspirin Alone After Ministroke
May 18, 2006 -- Researchers have spotted a drug combination that may help
survivors of ministrokes and minor strokes.
The drug combination is aspirin and the antiplatelet drug dipyridamole.
Dipyridamole is found in the drugs Aggrenox (which also contains aspirin) and
A study in The Lancet shows that among people who had already had a
transient ischemic attack (TIA, or “ministroke”) or a minor stroke, those who took
aspirin and dipyridamole were less likely to suffer a nonfatal stroke or heart
attack, have major bleeding
complications, or die of vascular problems (problems related to their
circulatory system) over 3.5 years.
The researchers included Ale Algra, MD, PhD, of the University Medical
Centre Utrecht in the Netherlands.
About the Study
The study was the European/Australasian Stroke Prevention in Reversible
Ischaemia Trial (ESPRIT). It included more than 2,700 patients from 79
hospitals in 14 countries.
The patients were 63 years old, on average. About two-thirds were men. None
had had recent heart attacks, limited life expectancy, or medical reasons why
they couldn’t take aspirin or dipyridamole.
The researchers randomly assigned patients to one of two drug plans:
- Aspirin alone
- Aspirin plus dipyridamole (preferably dipyridamole’s extended-release
Daily aspirin doses ranged from 30 milligrams to 325 milligrams.
Patients started on those plans within six months of their ministroke or
minor stroke. They were followed for 3.5 years, on average.
Algra and colleagues bundled together four events -- death from vascular
causes, nonfatal heart attack, nonfatal stroke, and major bleeding
During the study, 173 patients taking aspirin and dipyridamole experienced
at least one of those four events, compared with 216 who only took aspirin.
Those four events -- taken together -- were about 20% less likely in the
patients who took aspirin and dipyridamole compared with those who only took
aspirin. The results translate into an annual drop of 1% of those four events
during the follow-up period.
Then the researchers added in results from other recent studies on the
topic. They came up with a similar figure -- an 18% less likelihood of those
same four events with aspirin plus dipyridamole compared to aspirin alone.
Side Effects, Limits
In the aspirin-plus-dipyridamole group, 470 patients stopped taking their
drugs, compared to 184 assigned to aspirin alone.
Headaches, a possible side effect of dipyridamole, were the main reason for
the dropouts in the drug combination group, the study shows.
The study was an “open” trial, meaning that the treatments weren’t
concealed. “No large clinical trial is perfect and ESPRIT is no exception,”
states a journal editorial.
However, the ESPRIT trial echoes the findings of two other trials, which is
“a major strength,” writes editorialist Bo Norrving, MD, PhD, of the neurology
department at University Hospital in Lund, Sweden.
“With today’s report dual dipyridamole and aspirin therapy joins the podium
of well-established interventions to be applied in routine clinical practice in
secondary stroke prevention,” Norrving writes. “However, further improvements
are still needed and currently under study,” he adds.