Prof Armand Lowenthal, the Principal Investigator and Chairman of the European Stroke Prevention Study-2 (ESPS-2), presented the findings of this large trial at the Congress of the European Federation of Neurological Societies in Marseille, France, on September 11, 1995. In ESPS-2, 6602 patients with a history of stroke or transient ischemic attack were randomized to one of four groups: aspirin alone (50 mg/d), sustained-release dipyridamole alone (400 mg/d), aspirin plus sustained-release dipyridamole, or placebo. Medication was administered for a period of 2 years. Fifty-nine clinical centers in 13 European countries participated in the study. Two principal end points were defined: stroke or death from any cause. These end points were analyzed both separately and together. The incidence of stroke (both fatal and nonfatal) was relatively reduced by 18.1% with aspirin alone, by 16.3% with sustained-release dipyridamole alone, and by 37% with aspirin plus sustained-release dipyridamole. The combined end point of stroke and death from all causes was relatively reduced by 13.2% with aspirin alone, by 15.4% with sustained-release dipyridamole alone, and by 24.4% with aspirin plus sustained-release dipyridamole.
Of note, even this very low dose of aspirin was associated with an increase in gastrointestinal bleeding events (4.6% in placebo patients and sustained-release dipyridamole-alone patients versus 8.5% in aspirin-alone patients and aspirin-plus–sustained-release dipyridamole patients). The overall incidence of gastrointestinal side effects was similar for all four groups.
Prof Lowenthal concluded that in patients with a history of stroke or transient ischemic attack, sustained- release dipyridamole alone and low-dose aspirin alone are beneficial; however, combination therapy with both low-dose aspirin and sustained-release dipyridamole is effective in significantly reducing the risk of recurrent stroke or death. These results will be presented in the United States at the American Heart Association 21st International Joint Conference on Stroke and Cerebral Circulation in San Antonio, Tex, January 25-27, 1996.
- Copyright © 1996 by American Heart Association