Patients who had survived a
stroke or transient ischaemic attacks (TIA) were admitted to a trial of low-dose
aspirin (50 mg) alone, sustained release
dipyridamole (400 mg/day) alone, or a combination of the two agents, and results compared with a placebo over 24 months. This low-dose
aspirin regimen produced in pairwise comparisons a significant risk reduction of 18% for
stroke, 13% for
stroke and/or death but no reduction in all cause mortality. The sustained release
dipyridamole produced a significant risk reduction of 16% for
stroke, 15% for
stroke and/or death but no significant reduction of mortality. In combination,
aspirin and
dipyridamole produced a risk reduction of 37% in
stroke, 24% in
stroke and/or death, and no reduction in mortality. Similar findings were found in TIA, which was a secondary endpoint. These results are highly significant in comparison with placebo. As expected, there were enhanced reports of alimentary side-effects in the
aspirin groups and also enhanced
bleeding.
Dipyridamole was associated with a slight increase in
headache, which resolved in most patients if
therapy was continued. The conclusions are that 50 mg/day of
aspirin alone or 400 mg/day of sustained release
dipyridamole alone are equally effective in
stroke and TIA prevention. When used in combination the effects were additive and were significantly more effective than the single agents.