NEW YORK (Reuters Health) Nov 19 - According to pooled data from randomized controlled trials, dipyridamole and aspirin are more effective than aspirin alone in the secondary prevention of transient ischemic attack (TIA) or minor stroke, researchers report in the November issue of the Journal of Neurology, Neurosurgery and Psychiatry.
As investigator Dr. Philip M. W. Bath told Reuters Health, "this study pulls together all the available trial data and tells us that we can do better than aspirin alone in preventing recurrent stroke. Instead, we should be using the combination of aspirin and dipyridamole as our first-line therapy."
Dr. Bath of the University of Nottingham City Hospital, UK, and colleagues came to this conclusion after updating a meta-analysis, ultimately involving five studies and more than 7600 subjects.
Compared to the use of aspirin alone, the adjusted hazard ratio for the composite end-point of vascular death, non-fatal myocardial infarction or non-fatal stroke was 0.82 in the combination group.
This continued to be true in a variety of subgroups, including those based on age, sex, hypertension, diabetes, and previous stroke. The researchers, however, point out that data on risk factors were not available for all five trials, thus reducing the numbers available for analysis.
The combination was also more effective than aspirin alone in preventing recurrent stroke (hazard ratio, 0.78).
The superiority of the agents in concert, the investigators observe, is backed by sound evidence. Combination therapy, they conclude, "should be preferred over aspirin after a TIA or minor stroke of presumed arterial origin, as supported by several national guidelines."
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