Dipyridamole for Preventing Recurrent Ischemic Stroke and Other Vascular Events

Leonardi‐Bee, Jo; Bath, Philip M.W.; Bousser, Marie‐Germaine; Dávalos, Antoni; Diener, Hans‐Christoph; Guiraud-Chaumeil, B; Sivenius, Juhani; Yatsu, Frank M.; Dewey, Michael

doi:10.1161/01.str.0000149621.95215.ea

Cited by 116 publications

(46 citation statements)

References 22 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A pivotal study, ESPS-2 (European Stroke Prevention Study), showed that aspirin plus dipyridamole was significantly more effective than aspirin alone in secondary prevention of stroke (relative risk reduction 23.1%; p 0.006) and conveyed a similarly low risk of severe bleeding (1.6% vs 1.2%) 63) . Moreover, metaanalysis of 7 randomized trials was consistent with the ESPS-2 results 64) . ESPRIT (European/Australasian Stroke Prevention in Reversible Ischemia Trial) demonstrated that the incidence rate of the composite primary outcome (nonfatal MI, nonfatal stroke, vascular death, or major bleeding complication) was significantly lower in patients receiving aspirin plus dipyridamole than in those using aspirin alone (12.7% vs 15.7%, respectively; hazard ratio 0.80; 95% confidence interval 0.66-0.98) 65) ; however, aspirin plus dipyridamole was not superior to clopidogrel in the treatment of recurrent stroke in the recently completed PROFESS (Prevention Regimen for Effectively Avoiding Second Strokes) trial 66) .…”

Section: Phosphodiesterase Inhibitorssupporting

confidence: 78%

Role of Platelets and Antiplatelet Therapy in Cardiovascular Disease

Ueno

Kodali

Tello‐Montoliu

et al. 2011

JAT

View full text Add to dashboard Cite

Section: Phosphodiesterase Inhibitorssupporting

confidence: 78%

Role of Platelets and Antiplatelet Therapy in Cardiovascular Disease

Ueno

Kodali

Tello‐Montoliu

et al. 2011

JAT

View full text Add to dashboard Cite

“…A meta-analysis based on a systematic review of all the available individual patient data from randomized controlled trials involving dipyridamole in patients with prior ischemic stroke or TIA confirms the additive effects of aspirin and dipyridamole [17]. Dipyridamole was compared with placebo, and combined aspirin and dipyridamole with the monotherapies and with placebo.…”

Section: Combined Mr-dipyridamole and Aspirin -Drug Evaluationmentioning

confidence: 92%

Modified-Release Dipyridamole Combined with Aspirin for Secondary Stroke Prevention

Diener

2005

Aging Health

Self Cite

View full text Add to dashboard Cite

Patients suffering from transient ischemic attack (TIA) or ischemic stroke have a high risk of suffering a first or recurrent stroke, with an annual risk of between 5 and 15%. The European Stroke Prevention Study (ESPS)2 was a randomized, double-blind, placebocontrolled trial involving 6602 patients with TIA or stroke comparing aspirin alone (50 mg daily), modified-release (MR) dipyridamole alone (200 mg twice daily), aspirin plus dipyridamole, and placebo. The 2-year relative risk reduction of stroke in the aspirin plus MR-dipyridamole group (37.0%) was significantly higher than in either the aspirin group (18.1%) or the MR-dipyridamole group (16.3%). The results of the comparison between aspirin plus MR-dipyridamole versus placebo confirmed the findings of ESPS1. The results of ESPS2 were at odds with all prior trials with dipyridamole alone or in association with aspirin, but it was also the only trial sufficiently powered to show a significant difference. For this reason, a meta-analysis was performed based on a systematic review of individual patient data from randomized controlled trials involving dipyridamole in patients with prior ischemic stroke or TIA. Recurrent stroke was reduced by dipyridamole compared with placebo, and by combined aspirin and dipyridamole versus aspirin alone, dipyridamole alone or placebo. In two post hoc analyses the efficacy of aspirin plus extended-release dipyridamole was compared with aspirin alone for the prevention of recurrent stroke among high-risk groups. Stroke models from the Framingham Study and the Stroke Prognostic Instrument II were applied to subjects in ESPS2 to assign patients to risk groups. Compared with aspirin alone, aspirin plus MR-dipyridamole demonstrated a more pronounced efficacy in reducing the risk for stroke and vascular events among patients younger than 70 years of age, with hypertension, or prior stroke; current smokers; and those with any prior cardiovascular disease. Another model (Essen risk score) showed that patients with a high risk of recurrent stroke show a much greater benefit from aspirin plus MR-dipyridamole compared with aspirin monotherapy than patients with a low risk.Annually, 15 million people worldwide suffer a stroke, of whom 5 million die and 5 million are permanently disabled [1]. The age-related incidence of stroke is declining in many developed countries, largely as a result of the control of risk factors such as high blood pressure and smoking. The absolute number of strokes continue to increase because of the aging population. For example, stroke is the biggest single cause of disability in the UK. People who have an ischemic stroke or transient ischemic attack (TIA) are at high risk of a second stroke [2], although this risk ranges from approximately 5% to around 20% per year [3,4]. The recurrence risk is highest in the first few days after a TIA or stroke and declines with time. Such second strokes often cause substantial disability and greatly reduce quality of life.Evidence-based improvements to the prevention of second...

show abstract

“…One trial found that amphetamine increased BP and HR in stroke, 30 important as hypertension is a major risk factor for further stroke, 31 and for a poor outcome. 32 Furthermore, no data exist on the effect of amphetamine on central or cerebral haemodynamic in this population, despite recent evidence that these parameters can be related to outcome in acute stroke. 33,34 We performed a phase II trial assessing the effect of amphetamine on motor function, and cerebral and cardiac haemodynamics.…”

Section: Introductionmentioning

confidence: 99%

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

et al. 2007

View full text Add to dashboard Cite

Amphetamine enhances recovery after experimental ischaemia and has shown promise in small clinical trials when combined with motor or sensory stimulation. Amphetamine, a sympathomimetic, might have haemodynamic effects in stroke patients, although limited data have been published. Subjects were recruited 3-30 days post-ischaemic stroke into a phase II randomized (1:1), double-blind, placebo-controlled trial. Subjects received dexamphetamine (5 mg initially, then 10 mg for 10 subsequent doses with 3-or 4-day separations) or placebo in addition to inpatient physiotherapy. Recovery was assessed by motor scales (Fugl-Meyer (FM)), and functional scales (Barthel index (BI) and modified Rankin score (mRS)). Peripheral blood pressure (BP), central haemodynamics and middle cerebral artery blood flow velocity were assessed before, and 90 min after, the first two doses. Thirty-three subjects were recruited, aged 33-88 (mean 71) years, males 52%, 4-30 (median 15) days post stroke to inclusion. Sixteen patients were randomized to placebo and seventeen to amphetamine. Amphetamine did not improve motor function at 90 days; mean (s.d.) FM 37.6 (27.6) vs control 35.2 (27.8) (P ¼ 0.81). Functional outcome (BI, mRS) did not differ between treatment groups. Peripheral and central systolic BP, and heart rate (HR), were 11.2 mm Hg (P ¼ 0.03), 9.5 mm Hg (P ¼ 0.04) and 7 beats per minute (P ¼ 0.02) higher, respectively, with amphetamine, compared with control. A nonsignificant reduction in myocardial perfusion (BUI) was seen with amphetamine. Other cardiac and cerebral haemodynamics were unaffected. Amphetamine did not improve motor impairment or function after ischaemic stroke but did significantly increase BP and HR without altering cerebral haemodynamics.

show abstract

Dipyridamole for Preventing Recurrent Ischemic Stroke and Other Vascular Events

Cited by 116 publications

References 22 publications

Role of Platelets and Antiplatelet Therapy in Cardiovascular Disease

Role of Platelets and Antiplatelet Therapy in Cardiovascular Disease

Modified-Release Dipyridamole Combined with Aspirin for Secondary Stroke Prevention

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

Contact Info

Product

Resources

About