Aggrenox Superior to Aspirin

A large study confirms that Aggrenox (the combination of aspirin with dipyrimadole) is superior to aspirin alone for ischemic stroke prevention.

Summary:

(From the Lancet, 2006 May 20;367[9523]:1638-9.)

The ESPRIT study group (European/Australasian Stroke Prevention in Reversible Ischaemia Trial) organized a comparison study of aspirin alone versus the combination of extended-release dipyrimadole with aspirin for ischemic stroke prevention and the prevention of other forms of arterial occlusion.  Patients were entered into the trial within 6 months of having experienced a transient ischemic attack or small stroke of probable arterial origin and were followed for up to 5 years. A randomized trial design assigned patients to either aspirin alone (30-325mg daily; 1,376 people) or the same dosing of aspirin combined with long-acting dipyrimadole (200mg twice a day; 1,363 people).  Results were that 16% of those taking aspirin alone had a primary event (death from a blood vessel occlusion cause, non-fatal stroke, non-fatal heart attack, or major bleeding event) whereas only 13% of those on the combination therapy had such an event.  When the data from this trial was added to a meta-analysis of similar studies, the combination therapy was found to have an 18% reduction, compared to aspirin alone, for the primary outcomes listed above.

Commentary:

Platelets, small flat blood cells, can adhere to each other and contribute to blockage of an artery.  Aspirin is the most commonly used anti-platelet drug and has been demonstrated to reduce stroke and heart attack risk.  Dipyrimadole is a unique anti-platelet drug which, in this study, appears to work safely and effectively in combination with aspirin.

I have been an advocate of Aggrenox (aspirin plus extended release dipyrimadole) for the prevention of ischemic strokes, based on the results of a previous trial: ESPS-2, a European trial of similar design.  Some, though, were critical of this trial since it essentially stood alone, there being multiple prior trials of the combination of aspirin and dipyrimadole that did not demonstrate superiority to aspirin alone.  One important difference in the ESPS-2 trial, from prior trials, was the use of extended-release dipyrimadole, as opposed to short-acting dipyrimadole.  Extended-release dipyrimadole allows for more consistent blood levels throughout the day.  The ESPRIT trial is the second study to show that the combination of aspirin with extended-release dipyrimadole is superior to aspirin alone.  Critics may be more willing to accept the results of this study given now that the original result has been confirmed. 

Another criticism of the older ESPS-2 trial was that the dose of aspirin (50mg a day) was not adequate for a proper comparison.  Many neurologists and cardiologists felt that aspirin dosing should at least be as high as 75mg, for maximal stroke and heart attack prevention.  While the aspirin dose in the current trial was as low as 30mg in some patients, hopefully the fact that the median dose of aspirin for the overall trial was 75mg will put this criticism to rest.

Comments

[lowell norland]

i have been told my left carotid aRTERY IS 100% BLOCKED.

i HAD A MINI STROKE 6 WEEKS AGO.
SHOULD I TRY TO FINMD SOMEONE WHO WILL UNBLOCK MY ARTERY OR JUST CARRYON WITH AGGRENOX AND ASPIRINS???

[Yohhoo]

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[Browning]

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[Bobby]

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[steve02]

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