Dipyridamole with aspirin is better than aspirin alone in preventing vascular events after ischaemic stroke or TIA

doi:10.1136/bmj.39160.702188.AD

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Cathie Sudlow, clinical senior lecturer and honorary consultant neurologist

Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU

cathie.sudlow{at}ed.ac.uk

The clinical problem

After an ischaemic stroke or transient ischaemic attack (TIA), patients are at high risk of subsequent stroke and other vascular events, such as myocardial infarction. Strategies to prevent vascular events (stroke, myocardial infarction, or vascular death) in such patients include using aspirin, which is the most widely tested single antiplatelet drug for this purpose.1 2 Good evidence now exists, however, that adding dipyridamole to aspirin further reduces the risk in patients who have had an ischaemic stroke or transient ischaemic attack.

KEY POINTS

• In patients with a prior ischaemic stroke or transient ischaemic attack, adding the antiplatelet drug dipyridamole (modified release formulation, 200 mg twice daily) to aspirin reduces the relative risk of vascular events (stroke, myocardial infarction, or vascular death) by a fifth
• In patients already receiving current secondary preventive treatment, the average annual risk of a vascular event is no more than 5%; adding dipyridamole prevents one further vascular event for every 100 patients treated each year
• Headache may occur in up to a third of people taking dipyridamole but usually settles in one to two weeks