ESPRIT (European/Australasian Stroke Prevention in Reversible Ischaemia Trial)

Dipyridamole in Stroke Prevention – Effect of Dipyridamole on Blood Pressure

Trial data suggest that dipyridamole, with or without ASA, is more efficacious in the secondary prevention of stroke than of coronary events. This selective effect might be attributed to blood pressure lowering by dipyridamole. Therefore, we aimed to assess the effect on blood pressure in the setting of a randomised clinical trial in patients with cerebral ischaemia of presumed arterial origin.

Dipyridamole plus ASA versus ASA alone after cerebral ischaemia of arterial origin

ESPRIT was a randomised controlled trial in which the investigators assigned patients to ASA (30–325 mg daily) with (n=1,363) or without (n=1,376) dipyridamole (200 mg twice daily) within 6 months of a transient ischaemic attack or minor stroke of presumed arterial origin. The primary outcome event was the composite of death from all vascular causes, non-fatal stroke, non-fatal myocardial infarction, or major bleeding complication, whichever happened first. Treatment was open, but auditing of outcome events was blinded. Primary analysis was by intention to treat. Mean follow-up was 3.5 years (SD 2.0). Median ASA dose was 75 mg in both treatment groups (range 30–325); extended-release dipyridamole was used by 83% (n=1,131) of patients on the combination regimen.