Dipyridamole with aspirin for secondary stroke prevention

Abstract

In secondary prevention of stroke, aspirin has been hard to beat, because of its well-documented effect, small risk of serious side-effects, and minimum costs.1 However, the effect is small—only about a quarter of new vascular events are prevented, three-quarters are not. Of other antiplatelet drugs, the effect of dipyridamole alone is even more modest, whereas clopidogrel is only marginally better than aspirin at considerably higher costs.1–3 Can we do better? Today's Lancet features the results of ESPRIT, a randomised trial on the combination of aspirin and dipyridamole versus aspirin alone in 2739 patients with transient ischaemic attack and ischaemic stroke.