Consider The Evidence: Med/Peds Journal Roundup

May 31, 2006

Add Aggrenox? Here we go again. ESPRIT

Filed under: lancet, stroke — medblog @ 12:42 am

Lancet 5/20 – With the growing number of anti-thrombotic drugs, there seems to be a lack of consensus on exactly what anti-thrombotic regimen is to be used after major ischemic events such as stroke.

This weeks Lancet presents information from the ESPRIT trial – the latest study into the value of dipyridamole for treatment after CVA. The study was an RCT which assigned patients who experienced TIA / stroke within the previous 6 months to aspirin + dipyridamole vs aspirin alone.

In the end, the hazard ratio for major ischemic events was 0.81 in an intention to treat analysis. So the addition of dipyridamole to aspirin after an ischemic CVA lowered the risk of a  subsequent major ischemic event by about 20%. In addition the combination group had less (HR 0.67) bleeding complications. Unfortunately, about three times as many patients in the combo group dropped out, mostly due to headache. The effect was robust enough to be significant in an ITT analysis despite the high dropout rate.

Now if I could just get this whole Clodoprigel thing figured out….

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