The efficacy and safety of aspirin plus dipyridamole versus aspirin in secondary prevention following TIA or stroke: A meta-analysis of randomized controlled trials

Abstract

ObjectiveStroke is becoming a common disease worldwide, and has an increased rate of recurrence yearly after a transient ischemic attack (TIA) or stroke. Aspirin, dipyridamole, clopidogrel and aspirin plus dipyridamole combination therapy have been recommended for the secondary prevention of stroke in Americans. DesignWe performed meta-analyses to assess the effectiveness and safety of combination therapy with aspirin and dipyridamole (A+D) versus aspirin (A) alone in secondary prevention after transient ischemic attack (TIA) or stroke of presumed arterial origin within one week and six months. Data sourcesMedline, Embase, and the Cochrane Library. Selection of studiesEligible studies were completed randomized controlled trials investigating the effect of aspirin plus dipyridamole versus aspirin in patients with previous TIA or stroke. ResultsFive trials involving the use of aspirin and dipyridamole were included, 4318 allocated to A+D and 4304 to A alone. Meta-analysis of trials showed a significant protective effect of reducing or preventing recurrence of stroke (P=0.01), and ischemic event (P=0.003). The statistics showed no significant difference in vascular event, death from all cause and myocardial infarction (P>0.05). There were similarities with all bleeding events, major bleeding and intracranial hemorrhage was significant (P>0.05) between two groups. ConclusionsAspirin plus dipyridamole combination therapy was beneficial in reducing the recurrence of stroke, and did not increase the bleeding event. Hence, aspirin plus dipyridamole combination therapy is effective and safe for the secondary prevention of stroke.