Aspirin in combination with dipyridamole is better than aspirin alone for prevention of stroke

A study conducted by the European/Australasian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT) group in 2006 has finally resolved the uncertainty regarding whether to use aspirin alone or in combination in patients who have suffered stroke or are at high risk of stroke. The study found that combining aspirin with dipyridamole results in less deaths due to vascular problems, stroke or heart attack than using aspirin alone. Both drugs work by reducing the formation of dangerous blood clots which cause these diseases.

An ischaemic stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is blocked by a clot causing the brain tissue to die, leading to serious problems such as paralysis and speech difficulties. It is well known that patients who have suffered a stroke or a mini-stroke (transient ischaemic attack) are at increased risk of future stroke and disease so doctors need to employ several methods and treatments to prevent this occurring such as changing your lifestyle, quitting smoking and certain medications. Aspirin (a type of blood thinner) has been used for a long time and it is confirmed that this reduces the risk of further stroke but the effects are quite small. Numerous studies have therefore been conducted to search for new drugs and to determine the best method of treatment for patients. Unfortunately many of the studies comparing drug regimens produced conflicting results so doctors have not really been sure of the best treatment to prevent future strokes in their patients. A recent study published in the Lancet has finally overcome some of this confusion. Researchers of the European/Australasian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT) group found that aspirin combined with dipyridamole is better than aspirin alone, confirming results of another large study 10 years prior to this. Both aspirin and dipyridamole aim to reduce dangerous blood clots from forming in the blood which subsequently reduces the risk of future stroke. The study looked at 2739 patients who had had a transient ischaemic attack or ischaemic stroke (due to an arterial problem) within 6 months of entering the trial. Patients were randomly assigned to receive aspirin alone or in combination with dipyridamole and followed up for several years. It was found that those in the combination group had lower rates of death from all vascular causes, stroke and heart attack. When results of many studies were pooled the benefits were clearly apparent. However, combination therapy causes more side effects (especially headache) which can make patients cease taking treatment. The results of this study are really important as doctors now know the current best way to treat their patients who have suffered previous stokes or transient ischaemic attacks. This means that the many stroke sufferers in Australia can potentially receive better treatment which could prevent future disability and death. However, no study is perfect and more research is required to determine the best immediate treatments of stroke and ways to reduce side effects of treatment. In addition, this drug combination will only form part of the overall treatment plan so you should discuss your treatment completely with your doctor.Reference:ESPRIT Study Group. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial.Lancet 2006; 367: 1665-73.