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Ralph L. Sacco, MS, MD; Juhani Sivenius, MD, PhD; Hans-Christoph Diener, MD, PhD

Arch Neurol. 2005;62:403-408.

Objective  To assess the efficacy of aspirin plus extended-release dipyridamole compared with aspirin alone for the prevention of recurrent stroke among high-risk groups.

Design  A post hoc analysis was conducted using data from the European Stroke Prevention Study 2. Rates of annual strokes and vascular events were determined for the aspirin plus extended-release dipyridamole group (n = 1650) and the aspirin-only group (n = 1649), and were stratified by risk subgroup and univariate risk factors. Stroke models from the Framingham Study and the Stroke Prognostic Instrument II were applied to subjects in the European Stroke Prevention Study 2 to categorize patients into risk groups.

Results  Compared with aspirin alone, aspirin plus extended-release dipyridamole demonstrated a more pronounced efficacy in reducing the risk for stroke and vascular events among patients younger than 70 years; those with hypertension, prior stroke, or transient ischemic attack; current smokers; and those with any prior cardiovascular disease. Relative hazard reductions favored the combination of aspirin plus extended-release dipyridamole, and were greatest for the high-risk Framingham Study group and the moderate-risk Stroke Prognostic Instrument II subgroup.

Conclusion  Aspirin plus extended-release dipyridamole is more effective than aspirin alone at preventing stroke, and the difference in efficacy increases in higher-risk patients.

Author Affiliations: Departments of Neurology and Epidemiology, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, Neurological Institute, New York, NY (Dr Sacco); Department of Neuroscience and Neurology, Kuopio University Hospital, Brain Research and Rehabilitation Center Neuron, Kuopio, Finland (Dr Sivenius); and Department of Neurology, University Hospital Essen, Essen, Germany (Dr Diener).

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