Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke

Sacco, Ralph L., Diener, Hans-Christoph, Yusuf, Salim, Cotton, Daniel, Ounpuu, Stephanie, Lawton, William A., Palesch, Yuko, Martin, Renée H., Albers, Gregory W., Bath, Philip M.W., Bornstein, Natan, Chan, Bernard P.L., Chen, Sien-Tsong, Cunha, Luis, Dahlöf, Björn, De Keyser, Jacques, Donnan, Geoffrey A., Estol, Conrado, Gorelick, Philip, Gu, Vivian, Hermansson, Karin, Hillbrich, Lutz, Kaste, Markku, Lu, Chuanzhen, Machnig, Thomas, Pais, Prem, Roberts, Robin, Skvortsova, Veronika, Teal, Philip, Toni, Danilo, Vandermaelen, Cam, Voight, Thor, Weber, Michael and Yoon, Byung-Woo (2008) Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. New England Journal of Medicine, 359 (12). pp. 1238-1251. ISSN 0028-4793

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Recurrent stroke is a frequent, disabling event after ischemic stroke. This study compared

the efficacy and safety of two antiplatelet regimens — aspirin plus extendedrelease

dipyridamole (ASA–ERDP) versus clopidogrel.


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.


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).


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. ( number, NCT00153062.)

Item Type: Article
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Clinical Neuroscience
Identification Number:
Depositing User: Sayers, Hazel
Date Deposited: 11 Sep 2008 13:34
Last Modified: 04 May 2020 20:27

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