How Much Esprit Is in ESPRIT?

Abstract

Section Editors: Marc Fisher MD Kennedy Lees MD Stroke is the leading cause of disability in industrialized countries and poses an increasing burden on public and private healthcare systems. Owing to increasing life expectancy, the rate of first stroke is expected to continue to rise.1 In contrast, the rate of recurrent stroke is more susceptible to medical prevention strategies and therefore could be effectively reduced. In addition to control of the classic cardiovascular risk factors, both oral anticoagulants (vitamin K antagonists) and platelet inhibitors have been shown to decrease the relative risk of stroke recurrence by 13% to 67%.2 Several antiplatelet drugs have been investigated for the secondary prevention of stroke, including aspirin, ticlopidine, clopidogrel, and dipyridamole (DP). In addition, the combination of DP plus aspirin has been compared versus aspirin and the combination of clopidogrel plus aspirin versus aspirin3 or clopidogrel.4 In the following section, I will review the results from clinical trials investigating the benefit and risk of the combination of aspirin and DP versus placebo and aspirin monotherapy. In addition, I will compare the study design and results of t European Stroke Prevention Study 2 (ESPS2)5 and the recently published European/Australian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT) study.6 Early studies investigating the combination of DP plus aspirin versus aspirin monotherapy failed.7–9 Those trials used a rapid-release form of DP and were apparently underpowered in terms of sample size. ESPS2 was a randomized, double-blind, placebo-controlled trial that compared aspirin alone (50 mg daily), modified-release DP alone (200 mg twice daily), aspirin plus DP, and placebo in the …