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Letters to the Editor
July 2000

Dipyridamole Plus Aspirin in Cerebrovascular Disease

Arch Neurol. 2000;57(7):1086-1087. doi:

Drs Wilterdink and Easton1 performed an analysis of the trials that compared the use of the combination of dipyridamole plus aspirin vs aspirin alone for the individual and combined outcomes of stroke, myocardial infarction (MI), and vascular death. They feel that the most relevant outcome was all vascular events rather than just stroke. They point out that "uncertainty and prejudice regarding dipyridamole remain." They attribute this prejudice to 3 major factors: (1) "Most authorities demand at least 2 trials showing similar results before the findings can be accepted widely." (2) "While the addition of the ESPS-2 [European Stroke Prevention Study-22] results to the previous trials strongly suggests benefit for stroke prevention favoring combination dipyridamole plus aspirin over aspirin alone, the expected similar benefits for MI and vascular death are not seen." (3) "Published concerns over the conduct of the trial lower confidence of many practicing physicians in the study's results."