Dipyridamole for preventing stroke and other vascular events in patients with vascular disease

Schryver, ELLM De; Algra, Ale; Gijn, J. van

doi:10.1002/14651858.cd001820.pub2

Cited by 16 publications

(8 citation statements)

References 28 publications

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“…We also searched the Cochrane Database of Systematic Reviews using the terms dipyridamole, stroke, stroke prevention, and vascular disease and identified the most recent review, 11 from which we selected those clinical trials that met our eligibility criteria. Finally, we examined the reference lists of all relevant publications to locate additional studies meeting our eligibility criteria.…”

Section: Search Strategy For Identification Of Studiesmentioning

confidence: 99%

Aspirin Plus Dipyridamole Versus Aspirin for Prevention of Vascular Events After Stroke or TIA

Verro

Gorelick

Nguyen

2008

Stroke

106

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Background and Purpose-This meta-analysis systematically reviewed randomized controlled trials comparing aspirin plus dipyridamole with aspirin alone in patients with stroke and TIA to determine the efficacy of these agents in preventing recurrent cerebral and systemic vascular events. Methods-We performed separate analyses of the incidences of stroke alone and composite outcome of stroke, myocardial infarction, or vascular death. We also performed two subset analyses, planned a priori, to examine effect size based on trials using (1) exclusively immediate-release and (2) predominantly extended-release dipyridamole. Results-The summary results indicate a significant reduction in the overall risk ratio in favor of aspirin plus dipyridamole for stroke alone with relative risk 0.77 (0.67 to 0.89) and the composite end point with relative risk 0.85 (0.76 to 0.94). Studies using immediate-release dipyridamole showed a nonstatistically significant trend in favor of the combination for stroke alone with relative risk 0.83 (0.59 to 1.15) and for the composite outcome with relative risk 0.95 (0.75 to 1.19). Studies using predominantly extended-release dipyridamole showed a statistically significant difference in favor of the combination for stroke alone with relative risk 0.76 (0.65 to 0.89) and for the composite outcome with relative risk 0.82 (0.73 to 0.92). Conclusions-The combination of aspirin plus dipyridamole is more effective than aspirin alone in preventing stroke and other serious vascular events in patients with minor stroke and TIAs. The risk reduction was greater and statistically significant for studies using primarily extended release dipyridamole, which may reflect a true pharmacological effect or lack of statistical power in studies using immediate release dipyridamole.

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Section: Search Strategy For Identification Of Studiesmentioning

confidence: 99%

Aspirin Plus Dipyridamole Versus Aspirin for Prevention of Vascular Events After Stroke or TIA

Verro

Gorelick

Nguyen

2008

Stroke

106

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“…The extendedrelease form of dipyridamole has been studied in the ESPS-2 clinical trial only and replication of its effectiveness is warranted before widespread use of this antiplatelet preparation rather than aspirin or clopidogrel is advocated. A more recent meta-analysis by De Schryver et al 28 included randomized trials of individuals who were within 6 months after presentation of arterial vascular disease and who were treated for at least 1 month. 28 Starting therapy consisted of dipyridamole (in any dose) alone or added to another antiplatelet drug compared with placebo or antiplatelet drug(s) other than dipyridamole.…”

Section: Tia or Strokementioning

confidence: 99%

“…A more recent meta-analysis by De Schryver et al 28 included randomized trials of individuals who were within 6 months after presentation of arterial vascular disease and who were treated for at least 1 month. 28 Starting therapy consisted of dipyridamole (in any dose) alone or added to another antiplatelet drug compared with placebo or antiplatelet drug(s) other than dipyridamole. Dipyridamole alone or in combination with another antiplatelet agent compared with placebo reduced vascular events such as nonfatal stroke or nonfatal MI (dipyridamole vs placebo: RRR, 0.90; 95% CI, 0.83 to 0.98; aspirin combined with dipyridamole vs aspirin alone: RRR, 0.90; 95% CI, 0.80 to 1.00).…”

Section: Tia or Strokementioning

confidence: 99%

Oral Antiplatelet Therapy in Cerebrovascular Disease, Coronary Artery Disease, and Peripheral Arterial Disease

Tran

Anand

2004

JAMA

170

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“…In a newer meta-analysis (which included data from ESPRIT) comparing dipyridamole with or without another antiplatelet agent with control (placebo or antiplatelet drug other than dipyridamole), dipyridamole had no clear benefit in reducing the risk of vascular death (RR, 0.99; 95% CI, 0.87-1.12) but appeared to reduce the risk of vascular events (fatal and nonfatal stroke and MI: RR, 0.88: 95% CI, 0.81-0.95) compared with control, with the effects on cerebral ischemia reaching statistical significance. 27 These data were pooled from studies on patients with arterial vascular disease, including, but not limited to, TIA and stroke.…”

Section: Other Antiplatelet Agents In the Prevention Of Stroke After Tiamentioning

confidence: 99%

Antiplatelet Therapy for Transient Ischemic Attack

Acelajado

Oparil

2012

J of Clinical Hypertension

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J Clin Hypertens (Greenwich).****;**:**–**. ©2011 Wiley Periodicals, Inc. Transient ischemic attack (TIA) is currently defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction. TIA is an important risk factor for stroke and other major vascular events. Risk factors for TIA or stroke need to be addressed effectively to reduce the risk for stroke in patients who have had a TIA. Aspirin (ASA) significantly reduces the risk for stroke when given after a TIA, stroke, or myocardial infarction in a dose of 50 mg/d to 325 mg/d. The role of ASA in the primary prevention of TIA or stroke, however, is less well‐substantiated. Clopidogrel may be used in the secondary prevention of TIA or stroke, but its antiplatelet effect may be reduced in poor metabolizers of the drug. The combination of ASA and extended‐release dipyridamole is effective in reducing risk for TIA and stroke, and may confer additional risk‐lowering without an increased risk of bleeding compared with ASA alone. ASA monotherapy, clopidogrel alone, or the combination of ASA and extended‐release dypiridamole are all acceptable options for initial therapy in patients with a TIA and stroke, and the combination of ASA plus extended‐release dypiridamole is recommended over ASA alone.

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Dipyridamole for preventing stroke and other vascular events in patients with vascular disease

Cited by 16 publications

References 28 publications

Aspirin Plus Dipyridamole Versus Aspirin for Prevention of Vascular Events After Stroke or TIA

Aspirin Plus Dipyridamole Versus Aspirin for Prevention of Vascular Events After Stroke or TIA

Oral Antiplatelet Therapy in Cerebrovascular Disease, Coronary Artery Disease, and Peripheral Arterial Disease

Antiplatelet Therapy for Transient Ischemic Attack

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