Combination shows no advantage over aspirin alone

doi:10.1136/bmj.39212.715590.3A

BMJ 2007;334:1020 (19 May), doi:10.1136/bmj.39212.715590.3A

Letters

Dipyridamole with aspirin

Combination shows no advantage over aspirin alone

The first 150 words of the full text of this article appear below.

I disagree with Sudlow's recommendations.¹ The cited ESPRITstudy had lots of limitations. Firstly, during the study inclusioncriteria changed from a three arm to a two arm design.² ³ Secondly,patients and physicians were not blinded to the treatment regimen.The resulting confounder therefore cannot be estimated. Thirdly,possible lifestyle changes, comorbidity, and co-treatment werenot under examination.

Adherence in the dipyridamole-aspirin group was much less (2.6-fold)than in the aspirin group. The on-treatment analysis showedonly a small benefit for bleeding complications (hazard ratio0.58, 95% confidence interval 0.35 to 0.97). The analysis byintention to treat showed small benefits only in combined endpoints, which was driven by the single benefit in the occurrenceof non-fatal strokes. The combined treatment showed no advantagein death. The new occurrence of disability was not reported.Furthermore, the real benefit from a number needed to treatof 104 is small.⁴

In . . . [Full text of this article]

Manfred Gogol, head, geriatric department

Krankenhaus Lindenbrunn, Lindenbrunn 1, D-31863 Coppenbruegge, Germany

gogol@krankenhaus-lindenbrunn.de

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