Guidelines
International guidelines – Overview Secondary Prevention
Extended release dipyridamole + ASA is recommended as first line treatment in main European (EUSI and NICE) and US (ACCP) evidence-based treatment guidelines.
| ACCP | ESO | NICE* | RCP | |
|---|---|---|---|---|
| ER-DP = Extended-release Dipyridamole; ASA = Aspirin; CP = Clopidogrel * preliminary |
||||
| ASA | 50 – 325 mg (Grade 2A) |
50 – 325 mg Class I, Level A |
50 - 300 mg First Choice |
|
| ER-DP +ASA | ER-DP + ASA 25 mg/200 mg more effective than ASA and clopidogrel (Grade 1A) |
ER-DP + ASA Class I, Level A |
ER-DP + ASA for 2 years First Choice |
ER-DP + ASA First Choice |
| ER-DP | DP when ASA and Clopidogrel/ Ticlopidine not tolerated Class IV; GCP |
DP for intolerance of ASA, for 2 years Second Choice |
DP when ASA not tolerated Second Choice |
|
| CP | CP 75 mg (preferred over ASA) (Grade 2B) |
CP slightly more effective than ASA When ASA or DP not tolerated + high risk patients Class I, Level A |
CP for intolerance of both ASA and DP, for 2 years Third Choice |
CP First Choice Also when ASA not tolerated Second Choice |
Guidelines for the secondary prevention of stroke, such as those from ESO and from the American College of Chest Physicians (ACCP) advocate the use of appropriate antiplatelet therapy and state that there are three acceptable, first choice options: aspirin alone, the combination of aspirin with modified-release dipyridamole or clopidogrel alone. While the European recommendations do not favour one of the options, the combination of aspirin with dipyridamole is favoured as a first choice, in the ACCP guidelines, whereas the RCP recommend all the three antiplatelets on the same level.
References
Hacke W. ESC Mannheim 2004, updated by Kreutz J.
