Document Detail


Dipyridamole for preventing recurrent ischemic stroke and other vascular events: a meta-analysis of individual patient data from randomized controlled trials.
MedLine Citation:
PMID:  15569877     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Results from randomized controlled trials of dipyridamole, given with or without aspirin, for secondary prevention after ischemic stroke or transient ischemic attack (TIA) have given conflicting results. We performed a meta-analysis using individual patient data from relevant randomized controlled trials. METHODS: Randomized controlled trials involving dipyridamole in patients with previous ischemic stroke or TIA were sought from searches of the Cochrane Library, other electronic databases, references lists, earlier reviews, and contact with the manufacturer of dipyridamole. Individual patient data were merged from 5 of 7 relevant trials involving 11 459 patients. Results were adjusted for age, gender, qualifying event, and history of previous hypertension. RESULTS: Recurrent stroke was reduced by dipyridamole as compared with control (OR, 0.82; 95% CI, 0.68 to 1.00), and by combined aspirin and dipyridamole versus aspirin alone (OR, 0.78; 95% CI, 0.65 to 0.93), dipyridamole alone (OR, 0.74; 95% CI, 0.60 to 0.90), or control (OR, 0.61; 95% CI, 0.51 to 0.71). The point estimates obtained for the comparisons of aspirin and dipyridamole versus control (OR, 0.63; significant) or versus aspirin (OR, 0.88; nonsignificant) were similar if the data from the largest trial, ESPS II (which provided 57% of data), were excluded. Similar findings were observed for nonfatal stroke. The combination of aspirin and dipyridamole also significantly reduced the composite outcome of nonfatal stroke, nonfatal myocardial infarction, and vascular death as compared with aspirin alone (OR, 0.84; 95% CI, 0.72 to 0.97), dipyridamole alone (OR, 0.76; 95% CI, 0.64 to 0.90), or control (OR, 0.66; 95% CI, 0.57 to 0.75). Vascular death was not altered in any group. CONCLUSIONS: Dipyridamole, given alone or with aspirin, reduces stroke recurrence in patients with previous ischemic cerebrovascular disease. The combination of aspirin and dipyridamole also reduces the composite of nonfatal stroke, nonfatal myocardial infarction, and vascular death as compared with aspirin alone.
Authors:
Jo Leonardi-Bee; Philip M W Bath; Marie-Germaine Bousser; Antoni Davalos; Hans-Christoph Diener; Bernard Guiraud-Chaumeil; Juhani Sivenius; Frank Yatsu; Michael E Dewey;
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2004-11-29
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  36     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2004-12-24     Completed Date:  2005-09-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  162-8     Citation Subset:  IM    
Affiliation:
University of Nottingham, Nottingham, UK.
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MeSH Terms
Descriptor/Qualifier:
Aspirin / adverse effects,  therapeutic use
Blood Pressure / drug effects
Brain Ischemia / epidemiology,  prevention & control*
Dipyridamole / adverse effects,  therapeutic use*
Drug Therapy, Combination
Female
Humans
Ischemic Attack, Transient / epidemiology,  prevention & control
Male
Middle Aged
Myocardial Infarction / epidemiology,  prevention & control
Randomized Controlled Trials as Topic
Recurrence / prevention & control
Stroke / diagnosis,  epidemiology,  prevention & control*
Treatment Outcome
Chemical
Reg. No./Substance:
50-78-2/Aspirin; 58-32-2/Dipyridamole
Comments/Corrections
Comment In:
ACP J Club. 2005 Jul-Aug;143(1):10   [PMID:  15989298 ]

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