European Stroke Prevention Study 2

Evidence relating to the use of dipyridamole M/R accrues from the European Stroke Prevention Study 2 (ESPS2).

This randomised placebo-controlled trial demonstrated that the combination of dipyridamole M/R and aspirin had a small but significant added benefit over either dipyridamole M/R or aspirin alone in the scondary prevention of stroke with only a slight increase in adverse effects:

• strokes with combination 9.5% versus aspirin 12.5%; P<0.001; NNT = 34
• however there was no statistically significant reduction in death from all causes, and the combined endpoint of stroke and/or death was no quite significant (P=0.056) with the combination compared with aspirin.

Comparing dipyridamole M/R to aspirin alone there was no significant difference between therapies.

Adverse effects - bleeding episodes were significantly more serious and frequent in the aspirin containing groups.

Reference:

1. MTRAC (October 1998), Summary Sheet for; Dipyridamole M/R +/- aspirin.
2. Diener et al. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996 Nov;143(1-2):1-13.