March 28, 2008Stroke
Antiplatelet Therapy for Secondary Prevention of Noncardioembolic Ischemic Stroke
Key result
The combination of aspirin and extended-release dipyridamole reduces the relative odds of stroke, MI, or vascular death by 18% (OR 0.82; 95% CI 0.74-0.91) compared with aspirin alone.
Why the study?
What is the comparative efficacy of various antiplatelet therapies for secondary prevention in patients with noncardioembolic ischemic stroke or TIA?
Population
Patients with ischemic stroke or transient ischemic attack caused by atherothromboembolism
Comparison
Antiplatelet therapy vs Placebo or aspirin alone
Design
Review
Authors
Discussion
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Member takes
Implication
May support aspirin-dipyridamole for secondary noncardioembolic stroke prevention; leaves open optimal regimens in contemporary cohorts.
Structured PICO
What is the comparative efficacy of various antiplatelet therapies for secondary prevention in patients with noncardioembolic ischemic stroke or TIA?
P
Population
Patients with ischemic stroke or transient ischemic attack caused by atherothromboembolism
I
Intervention
Antiplatelet therapy (aspirin, clopidogrel, aspirin + extended-release dipyridamole, cilostazol)
C
Comparator
Placebo or aspirin alone
O
Outcome
Composite of recurrent stroke, MI, and death attributable to vascular causescomposite
Main Result
Effect estimate: OR 0.82 (95% CI 0.74-0.91)
For secondary prevention of noncardioembolic stroke, aspirin + extended-release dipyridamole or clopidogrel offer modest benefits over aspirin alone, while aspirin + clopidogrel increases major bleeding.
Cite This Study
O’Donnell et al. (2008) conducted a review in Ischemic stroke or transient ischemic attack caused by atherothromboembolism. Antiplatelet Therapy (e.g., Aspirin and extended-release dipyridamole) vs. Aspirin alone was evaluated on Stroke, MI, or vascular death (OR 0.82, 95% CI 0.74-0.91). The combination of aspirin and extended-release dipyridamole reduces the relative odds of stroke, MI, or vascular death by 18% (OR 0.82; 95% CI 0.74-0.91) compared with aspirin alone.