Randomized controlled trials have established the superiority of aspirinER
dipyridamole over
aspirin alone for secondary
stroke prevention. One limitation of this product is the potential risk of worsening angina in patients with
coronary artery disease. The English-language medical literature was searched for articles describing the cardiac safety of oral
dipyridamole alone or in combination with
aspirin. Meta-analyses, randomized controlled trials, observational studies, and case reports presenting information on the cardiac safety of oral
dipyridamole were also reviewed. Four meta-analyses described vascular events with
dipyridamole using various dosing strategies. Three trials included the endpoint of
myocardial infarction in patients receiving ER
dipyridamole. The meta-analyses and randomized controlled trials specifically evaluating
aspirin-ER
dipyridamole did not provide evidence of increased risk of vascular events. One post hoc analysis of a randomized controlled trial specifically assessed the cardiac safety of fixed-dose
aspirin-ER
dipyridamole and found that
dipyridamole was not associated with a higher number of
cardiac events compared with
aspirin alone. One randomized controlled trial evaluated the efficacy of ER
dipyridamole in patients with preexisting
ischemic heart disease and found no evidence of increased risk of
cardiac events in this population. No published reports were located describing angina with the combination product.
CONCLUSION: