(a) Sivenius J, Cunha L, Diener H-C, Forbes C, Laakso M, Lowenthal A, Smets P, Riekkinen P Sr
(b) Sivenius J, Cunha L, Diener H-C, Forbes C, Laakso M, Lowenthal A, Smets P, Riekkinen P Sr

(a) Second European Stroke Prevention Study: antiplatelet therapy is effective regardless of age
(b) Antiplatelet treatment does not reduce the severity of subsequent stroke

(a) Acta Neurol Scand 1999;99:54-60
(b) Neurology 1999;53:825-9

Stroke

To investigate the efficacy of low-dose aspirin and modified-release dipyridamole alone or in combination in the secondary prevention of ischaemic stroke, to assess the effect of age on this efficacy, and to assess the effect of this antiplatelet therapy on the severity of subsequent stroke

Randomised, double-blind, placebo-controlled, 2 × 2 factorial

2 years

6602 patients (1649 aspirin alone, 1654 dipyridamole alone, 1650 aspirin plus dipyridamole, 1649 placebo), of whom 2565 aged < 65 years, 2240 aged 65-74 years, 1797 aged ≥ 75 years, with TIA or ischaemic stroke < 3 months

Aspirin, 25 mg bid, modified-release dipyridamole, 200 mg bid, combination aspirin and dipyridamole, or placebo

Combination therapy significantly reduced the incidence of stroke, death, stroke and/or death, and other vascular events in each age group. Advancing age was associated with an increased incidence of these endpoints in all treatment groups. Age had no influence on the efficacy of antiplatelet therapy for any of the evaluated endpoints. Relative risk reductions compared to placebo were 11.1-27.6% in the aspirin group, 8.0-18.7% in the dipyridamole group and 20.3-45.2% in the combination group. For 701 patients for whom the initial Rankin score was known, there were no significant difference between the treatment groups in the change in Rankin score between entry and recurrent stroke. The time to recurrent stroke was longest in the combination therapy group (p = 0.057), but therapy did not delay the time to death during follow-up