title: Comparative evaluation of treatment with low-dose aspirin plus dipyridamole versus aspirin only in patients with acute ischaemic stroke.
abstract: BACKGROUND
  Previous studies have suggested that pre-stroke treatment with low-dose aspirin (A) could reduce the severity of acute ischaemic stroke, but less is known on the effect of pre-stroke treatment with a combination of aspirin and dipyridamole (A + D) and post-stroke effects of these drugs. The aim of the present study was to evaluate the effect of this drug combination on acute and long-term prognosis of ischaemic stroke.
  
  
  METHODS
  Patients without atrial fibrillation admitted to the stroke unit with acute ischaemic stroke (n = 554) or TIA (n = 108) were studied during acute hospital care and up to 12 months after discharge from hospital.
  
  
  RESULTS
  Prior to acute stroke 62 patients were treated with A + D while 247 patients were treated with A only. No beneficial effects of the combination A + D compared to A only were noted on stroke severity and/or acute in-hospital mortality. However, survival analysis by Cox-proportional hazard model demonstrated lower 12-months all-cause mortality in patients discharged with A + D (n = 275) compared with patients on A only (HR, 0.52; CI, 0.32-0.86; p = 0.011; n = 262) after adjusting for age, baseline NIHSS, previous stroke, previous myocardial infarction and type 2 diabetes. We also noted a tendency towards lower all-cause mortality at 3 months with use of A + D, but this was not statistically significant (p = 0.12).
  
  
  CONCLUSIONS
  Pre-stroke treatment with a combination of low-dose A + D does not reduce the severity of acute stroke, nor does it reduce the acute in-hospital mortality. However, treatment with A + D at discharge from hospital is seemingly associated with lower long-term mortality compared with A only, contrary to the results from previous randomised studies. However, our results must be interpreted with extreme caution considering the non-randomised study design.
authors.affiliation: Department of Internal Medicine, The Stroke Unit, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Lola
authors.initials: L
authors.lastname: Arnarsdottir
authors.forename: Clara
authors.initials: C
authors.lastname: Hjalmarsson
authors.forename: Lena
authors.initials: L
authors.lastname: Bokemark
authors.forename: Björn
authors.initials: B
authors.lastname: Andersson
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D015897:Comorbidity; D004176:Dipyridamole / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D015995:Prevalence; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D001241:Aspirin