Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
February 25, 2010StrokeOpen Access

Effect of Combined Aspirin and Extended-Release Dipyridamole Versus Clopidogrel on Functional Outcome and Recurrence in Acute, Mild Ischemic Stroke

View Full Paper
Ask AI
Bookmark
Share

Key result

Combined aspirin and extended-release dipyridamole did not differ from clopidogrel for functional outcome at 30 days in acute, mild ischemic stroke (OR 0.97; 95% CI 0.79-1.19).

Why the study?

Does combined aspirin and extended-release dipyridamole improve functional outcome at 30 days compared to clopidogrel in patients with acute, mild ischemic stroke?

Population

1360 patients randomized within 72 hours of acute, mild ischemic stroke

Comparison

Combined aspirin and extended-release dipyridamole vs Clopidogrel (75 mg/d)

Design

RCT, Randomized within 72 hours of ischemic stroke

Follow-up

90 days

Authors

PBPhilip M. BathVascular MedicineRMRenée H. MartinMedical University of South CarolinaYPYuko Y. PaleschUniversity of Southern California

Discussion

Loading...

Member takes

Implication

No functional advantage for aspirin-dipyridamole over clopidogrel at 30 days in mild acute ischemic stroke; confirms similar efficacy of these antiplatelet regimens.

Key Points

  • To compare the safety and efficacy of combined aspirin and extended-release dipyridamole versus clopidogrel on functional recovery and recurrence in patients with acute, mild ischemic stroke.
  • Post hoc subgroup analysis of the randomized factorial PRoFESS trial evaluating 1,360 patients enrolled within 72 hours of ischemic stroke onset (mean 58 hours).
  • Patients were randomized to receive aspirin (25 mg BID) plus extended-release dipyridamole (200 mg BID, n=672) or clopidogrel (75 mg daily, n=688).
  • Primary endpoint was 30-day functional outcome (shift analysis of modified Rankin Scale score); secondary outcomes included stroke recurrence, major bleeding, and death by 90 days.
  • Shift analysis of 30-day modified Rankin Scale scores for death or dependency showed no difference between aspirin/extended-release dipyridamole and clopidogrel (OR=0.97; 95% CI, 0.79 to 1.19).
  • Nonsignificant trends favored aspirin/extended-release dipyridamole for stroke recurrence (OR=0.56; 95% CI, 0.26 to 1.18) and vascular events (OR=0.71; 95% CI, 0.36 to 1.37) by 90 days.
  • Treatment discontinuation was higher with aspirin/extended-release dipyridamole than clopidogrel (18.0% [121/672] vs 12.5% [86/688], P=0.006), while rates of major bleeding, serious adverse events, and death were similar.

Study Design

Type

RCT (n=1,360)

Randomization

randomized

Structured PICO

Does combined aspirin and extended-release dipyridamole improve functional outcome at 30 days compared to clopidogrel in patients with acute, mild ischemic stroke?

P
Population
1,360 patients with acute, mild ischemic stroke randomized within 72 hours to combined aspirin-dipyridamole or clopidogrel, followed for 90 days.
I
Intervention
Combined aspirin (25 mg BID) and extended-release dipyridamole (200 mg BID)
C
Comparator
Clopidogrel (75 mg/d)
O
Outcome
Functional outcome at 30 days (combined death or dependency assessed via shift analysis of modified Rankin Scale score)hard clinical

Main Result

Odds Ratio: 0.97 (95% CI 0.79–1.19)

In patients with acute, mild ischemic stroke, combined aspirin and extended-release dipyridamole did not significantly improve functional outcomes or reduce recurrence compared to clopidogrel.

Limitations

  • Post hoc subgroup analysis

Cite This Study

Bath et al. (2010) conducted an RCT in acute, mild ischemic stroke (n=1,360). Combined aspirin and extended-release dipyridamole vs. Clopidogrel (75 mg/d) was evaluated on Functional outcome at 30 days (combined death or dependency) (OR 0.97, 95% CI 0.79-1.19). Combined aspirin and extended-release dipyridamole did not differ from clopidogrel for functional outcome at 30 days in acute, mild ischemic stroke (OR 0.97; 95% CI 0.79-1.19).

synapsesocial.com/papers/6a86f5b3540b033b21bf00b3https://doi.org/10.1161/strokeaha.109.564906

Topics

Dual antiplatelet therapy
View Full Paper
Ask AI
Bookmark
Share

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1EUROPEAN STROKE PREVENTION STUDY 2: DIPYRIDAMOLE AND ACETYLSALICYLIC ACID IN THE SECONDARY PREVENTION OF STROKE1997 · 1,412 citations
  2. 2Aspirin at any dose above 30 mg offers only modest protection after cerebral ischaemia.1996 · 256 citations
  3. 3Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke2008 · 969 citations
  4. 4Rationale, Design and Baseline Data of a Randomized, Double-Blind, Controlled Trial Comparing Two Antithrombotic Regimens (a Fixed-Dose Combination of Extended-Release Dipyridamole plus ASA with Clopidogrel) and Telmisartan versus Placebo in Patients with Strokes: The Prevention Regimen for Effectively Avoiding Second Strokes Trial (PRoFESS)2007 · 170 citations
  5. 5Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events2006 · 2,840 citations