Antiplatelet Treatment Does not Reduce the Severity of Subsequent Stroke
Abstract & commentary
Source: Sivenius J, et al. Antiplatelet treatment does not reduce the severity of subsequent stroke. European Stroke Prevention Study 2 Working Group. Neurology 1999;53: 825-829.
The european stroke prevention study (esps) published in 1996 demonstrated the benefit of a combination of aspirin and dipyridamole (twice daily 25 mg aspirin with 200 mg slow-release dipyridamole) over either agent alone or placebo (Diener HC, et al. J Neurol Sci 1996;143:1-13). The combination regime produced a 37% risk reduction for stroke, compared to 18% for aspirin alone. Sivenius and colleagues now present an analysis of 701 patients with stroke during two-year follow-up of the original 6602 patients in the ESPS2 cohort. Using the Rankin outcome scale, there was no difference in stroke severity among the four groups studied. This disability score measures the important outcome of functional status, but is not sensitive to neurologic subtleties such as dysphasia or a visual field defect. In keeping with the original results of the ESPS2 study, time to recurrent stroke was longest in the group that received combination therapy.
Commentary
In vitro evidence has suggested that aspirin may exert a neuroprotective effect independent of its antithrombotic properties (Grilli M, et al. Science 1996;274:1383-1385). In clinical trials, however, stroke has been shown to be equally severe among patients on a range of aspirin doses (100-500 mg) or on no prior aspirin therapy (Karcpov V, et al. Arch Neurol 1997;54:1369-1371). The current analysis by Sivenius et al further supports this. Aspirin and other antiplatelet agents remain the mainstay of stroke prophylaxis. However, when these agents fail, the size of the thrombus and extent of ischemic damage are likely the same, regardless of prior therapy. —azs
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