Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke
Research output: Contribution to journal › Journal article › Research › peer-review
BACKGROUND: Recurrent stroke is a frequent, disabling event after ischemic stroke. This study compared the efficacy and safety of two antiplatelet regimens--aspirin plus extended-release dipyridamole (ASA-ERDP) versus clopidogrel.
METHODS: In this double-blind, 2-by-2 factorial trial, we randomly assigned patients to receive 25 mg of aspirin plus 200 mg of extended-release dipyridamole twice daily or to receive 75 mg of clopidogrel daily. The primary outcome was first recurrence of stroke. The secondary outcome was a composite of stroke, myocardial infarction, or death from vascular causes. Sequential statistical testing of noninferiority (margin of 1.075), followed by superiority testing, was planned.
RESULTS: A total of 20,332 patients were followed for a mean of 2.5 years. Recurrent stroke occurred in 916 patients (9.0%) receiving ASA-ERDP and in 898 patients (8.8%) receiving clopidogrel (hazard ratio, 1.01; 95% confidence interval [CI], 0.92 to 1.11). The secondary outcome occurred in 1333 patients (13.1%) in each group (hazard ratio for ASA-ERDP, 0.99; 95% CI, 0.92 to 1.07). There were more major hemorrhagic events among ASA-ERDP recipients (419 [4.1%]) than among clopidogrel recipients (365 [3.6%]) (hazard ratio, 1.15; 95% CI, 1.00 to 1.32), including intracranial hemorrhage (hazard ratio, 1.42; 95% CI, 1.11 to 1.83). The net risk of recurrent stroke or major hemorrhagic event was similar in the two groups (1194 ASA-ERDP recipients [11.7%], vs. 1156 clopidogrel recipients [11.4%]; hazard ratio, 1.03; 95% CI, 0.95 to 1.11).
CONCLUSIONS: The trial did not meet the predefined criteria for noninferiority but showed similar rates of recurrent stroke with ASA-ERDP and with clopidogrel. There is no evidence that either of the two treatments was superior to the other in the prevention of recurrent stroke. (ClinicalTrials.gov number, NCT00153062.)
Original language | English |
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Journal | New England Journal of Medicine |
Volume | 359 |
Issue number | 12 |
Pages (from-to) | 1238-51 |
Number of pages | 14 |
ISSN | 0028-4793 |
DOIs | |
Publication status | Published - 18 Sep 2008 |
- Aged, Angiotensin-Converting Enzyme Inhibitors, Aspirin, Benzimidazoles, Benzoates, Brain Ischemia, Delayed-Action Preparations, Dipyridamole, Double-Blind Method, Drug Therapy, Combination, Factor Analysis, Statistical, Female, Hemorrhage, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction, Platelet Aggregation Inhibitors, Proportional Hazards Models, Risk, Secondary Prevention, Stroke, Ticlopidine, Vascular Diseases
Research areas
ID: 128985255