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Dipyridamole, ASA and warding off stroke

October 25, 2005

In this article, Dr. Cathie Sudlow, one of the investigators in a major randomized controlled clinical trial of antiplatelet therapy for stroke and myocardial infarction in high risk patients, comments on the recent decision by the influential U.K National Institute for Heath and Clinical Excellence (NICE) to recommend that dipyridamole be recommended in addition to ASA, rather than using ASA alone as most guidelines recommend. Dr. Sudlow states that this recommendation goes "beyond what is justified by the current evidence."

Given the frequency of stroke and TIA and the devastating consequences, preventing recurrence is important for patients and their physicians.

Patients who had had a stroke or a TIA and were randomized to take ASA plus dipyridamole compared to ASA alone had increased rates of myocardial infarction, although the results were marginally not significant.

ASA in doses between 75 and 150 mg/d should remain the gold standard of treatment to prevent stroke in high-risk patients (those who have had a previous stroke or a TIA), according to Dr. Sudlow's analysis. Further, the addition of dipyridamole, as now recommended by NICE, is rarely justified, even in-patients who have suffered another stroke while taking ASA.

Canadian Medical Association Journal