Aspirin and Dipyridamole No Better (or Worse) than Clopidogrel for Recurrent Stroke

A comparison of two antiplatelet regimens failed to show the superiority of either one in preventing stroke recurrence, according to a study released early by the New England Journal of Medicine.

Investigators for the PRoFESS Study Group randomized some 20,000 patients either to twice daily aspirin plus extended-release dipyridamole or to daily clopidogrel. (Patients also received an angiotensin-receptor blocker or placebo as part of a larger study design.) Drug-industry sponsors helped design and conduct the study.

After a mean follow-up of 30 months, the authors concluded that neither regimen showed an advantage for preventing stroke recurrence.

Harlan Krumholz, writing in Journal Watch Cardiology, observes: "There seems to be little difference between the two regimens; the only advantage found in this comparison goes to clopidogrel, which conferred a slightly lower risk for major hemorrhagic stroke than did aspirin plus extended-release dipyridamole."

NEJM's editorialists offer a haiku: "For stroke prevention,/ use an antiplatelet drug./ Treat hypertension."