Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2006 May 20;367(9523):1665-73.
doi: 10.1016/S0140-6736(06)68734-5.

Aspirin Plus Dipyridamole Versus Aspirin Alone After Cerebral Ischaemia of Arterial Origin (ESPRIT): Randomised Controlled Trial

Randomized Controlled Trial

Aspirin Plus Dipyridamole Versus Aspirin Alone After Cerebral Ischaemia of Arterial Origin (ESPRIT): Randomised Controlled Trial

ESPRIT Study Group et al. Lancet. .

Erratum in

  • Lancet. 2007 Jan 27;369(9558):274


Background: Results of trials of aspirin and dipyridamole combined versus aspirin alone for the secondary prevention of vascular events after ischaemic stroke of presumed arterial origin are inconsistent. Our aim was to resolve this uncertainty.

Methods: We did a randomised controlled trial in which we assigned patients to aspirin (30-325 mg daily) with (n=1363) or without (n=1376) dipyridamole (200 mg twice daily) within 6 months of a transient ischaemic attack or minor stroke of presumed arterial origin. Our 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. This study is registered as an International Standard Randomised Controlled Trial (number ISRCTN73824458) and with (NCT00161070).

Findings: Mean follow-up was 3.5 years (SD 2.0). Median aspirin dose was 75 mg in both treatment groups (range 30-325); extended-release dipyridamole was used by 83% (n=1131) of patients on the combination regimen. Primary outcome events arose in 173 (13%) patients on aspirin and dipyridamole and in 216 (16%) on aspirin alone (hazard ratio 0.80, 95% CI 0.66-0.98; absolute risk reduction 1.0% per year, 95% CI 0.1-1.8). Addition of the ESPRIT data to the meta-analysis of previous trials resulted in an overall risk ratio for the composite of vascular death, stroke, or myocardial infarction of 0.82 (95% CI 0.74-0.91). Patients on aspirin and dipyridamole discontinued trial medication more often than those on aspirin alone (470 vs 184), mainly because of headache.

Interpretation: The ESPRIT results, combined with the results of previous trials, provide sufficient evidence to prefer the combination regimen of aspirin plus dipyridamole over aspirin alone as antithrombotic therapy after cerebral ischaemia of arterial origin.

Comment in

Similar articles

See all similar articles

Cited by 178 articles

  • Antithrombotic Management After Intracranial Hemorrhage.
    Cajavilca CE, Hooper D, Imran R, Gadhia RR. Cajavilca CE, et al. Curr Treat Options Cardiovasc Med. 2019 Dec 10;21(12):88. doi: 10.1007/s11936-019-0771-y. Curr Treat Options Cardiovasc Med. 2019. PMID: 31823078 Review.
  • Antithrombotic Management of Ischemic Stroke.
    Sloane KL, Camargo EC. Sloane KL, et al. Curr Treat Options Cardiovasc Med. 2019 Dec 3;21(11):78. doi: 10.1007/s11936-019-0778-4. Curr Treat Options Cardiovasc Med. 2019. PMID: 31792720 Review.
  • Platelet function testing in pigs using the Multiplate┬« Analyzer.
    Heringer S, Kabelitz L, Kramer M, Nikoubashman O, Brockmann MA, Kirschner S, Wiesmann M. Heringer S, et al. PLoS One. 2019 Aug 29;14(8):e0222010. doi: 10.1371/journal.pone.0222010. eCollection 2019. PLoS One. 2019. PMID: 31465489 Free PMC article.
  • Antiplatelet Therapy in Cerebral Small Vessel Disease.
    Bouasquevisque DS, Benavente OR, Shoamanesh A. Bouasquevisque DS, et al. Curr Neurol Neurosci Rep. 2019 Jul 27;19(9):61. doi: 10.1007/s11910-019-0979-y. Curr Neurol Neurosci Rep. 2019. PMID: 31352655 Review.
  • Antiplatelet Therapy After Noncardioembolic Stroke.
    Greving JP, Diener HC, Reitsma JB, Bath PM, Csiba L, Hacke W, Kappelle LJ, Koudstaal PJ, Leys D, Mas JL, Sacco RL, Algra A. Greving JP, et al. Stroke. 2019 Jul;50(7):1812-1818. doi: 10.1161/STROKEAHA.118.024497. Epub 2019 Jun 10. Stroke. 2019. PMID: 31177983 Free PMC article.
See all "Cited by" articles

Publication types

MeSH terms

Associated data