patients (n=2739) were recruited from 79 hospitals in 14 countries within 6 months of a transient ischaemic attack (TIA) or non-disabling stroke of presumed arterial origin
patients were assigned aspirin (30–325mg daily, mean 75mg) with or without dipyridamole (200mg twice daily)
majority (83%) of the patients allocated dipyridamole received the modified-release formulation
follow-up was for up to eight years (mean 3.5 years)
primary outcome event was the composite of death from all vascular causes, non-fatal stroke, non-fatal myocardial infarction (MI), or major bleeding complications
primary analysis was by intention to treat
study results:
fewer patients in the aspirin plus dipyridamole group had a primary outcome event compared with those in the aspirin alone group (12.7% vs. 15.7%; hazard ratio [HR] 0.80, 95%CI 0.66–0.98)
number needed to treat [NNT] was 33 over 3.5 years
annual absolute risk reduction was 0.96% (NNT 104 per year, 95%CI 55-1006)
no significant difference in all-cause mortality (aspirin plus dipyridamole 6.8% vs. aspirin alone 7.8%; HR 0.88, 95%CI 0.67–1.17)
adverse effects:
higher proportion of patients discontinued treatment with the combination than with aspirin alone (34% vs. 13%) - mainly due to adverse effects
in 26% of cases headache was at least partly responsible in those who discontinued the combination
no statistically significant difference between the incidences of major (combination 3% vs. aspirin alone 4%) or minor (both 12%) bleeding
the ESPRIT study supports the prescribing of a combination of modified-release dipyridamole and low-dose aspirin for patients who have had a transient ischaemic attack (TIA) or non-disabling ischaemic stroke (2)
Notes:
there are various limitations with this study (2)
over 40% of patients were prescribed 30mg of aspirin, a dose below that currently recommended in UK guidelines
study also failed to report or take account of the use of other secondary preventative measures, such as blood pressure control, smoking cessation and lipid-lowering
at baseline, proportion of study who smoked (36%), had hypertension (60%) , hyperlipidaemia (46%)
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