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Cochrane review: dipyridamole for preventing major vascular events in patients with vascular disease
E L L M De Schryver1, A Algra, J van Gijn
1University Medical Center Utrecht, Utrecht, Netherlands.
Insights
Dipyridamole did not reduce vascular death risk in patients with arterial vascular disease. While it may reduce vascular events, this benefit was mainly seen in a single trial of patients after cerebral ischemia.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Patients with a history of nondisabling cerebral ischemia face a 4-11% annual risk of vascular events.
- Aspirin has demonstrated a 13% reduction in vascular event incidence.
- The efficacy of dipyridamole in secondary vascular event prevention, alone or combined with other antiplatelet drugs, requires systematic evaluation.
Purpose of the Study:
- To systematically compare the efficacy and safety of dipyridamole versus control in secondary vascular event prevention.
- To assess dipyridamole's effectiveness in the presence and absence of other antiplatelet drugs.
- To evaluate dipyridamole's role in patients with existing vascular disease.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials with concealed treatment allocation.
- Included trials focused on nonembolic arterial vascular disease.
- Compared dipyridamole (alone or with other antiplatelet drugs) against no drug or other antiplatelet therapies.
Main Results:
- Twenty-six trials involving 19,842 patients were analyzed.
- Dipyridamole did not significantly reduce vascular death risk (RR, 1.02; 95% CI, 0.90-1.17).
- A potential reduction in vascular events was observed (RR, 0.90; 95% CI, 0.83-0.98), primarily driven by a large trial in cerebral ischemia patients.
- Combination therapy with dipyridamole and aspirin showed no significant benefit over aspirin alone for vascular death (RR, 1.03; 95% CI, 0.87-1.22) or vascular events (RR, 0.90; 95% CI, 0.80-1.00).
Conclusions:
- Dipyridamole, with or without other antiplatelet drugs, did not demonstrate efficacy in reducing vascular death in patients with arterial vascular disease.
- A possible benefit of dipyridamole in reducing vascular events was noted, but this was largely attributed to a single trial in post-cerebral ischemia patients.
- Further research comparing dipyridamole plus aspirin to aspirin monotherapy is warranted.
Background:
Patients enrolled in clinical trials after nondisabling cerebral ischemia have an annual risk of vascular events (death from all vascular causes, nonfatal stroke, or nonfatal myocardial infarction) of 4% to 11%. Aspirin reduces the incidence by 13%. Many trials in patients presenting with vascular disease investigated the efficacy of (addition of) dipyridamole in secondary prevention. We systematically compared the efficacy and safety of dipyridamole versus control in the presence and absence of other antiplatelet drugs in clinical trials on the secondary prevention of vascular events in patients with vascular disease.
Summary Of Review:
Randomized trials with concealed treatment allocation in patients with a nonembolic arterial vascular disease were selected. Therapy consisted of dipyridamole in the presence or absence of other antiplatelet drugs compared with no drug or an antiplatelet drug(s) other than dipyridamole. Twenty-six trials were included, with a total of 19 842 patients. Dipyridamole was not more efficacious in the prevention of vascular death (relative risk [RR], 1.02; 95% CI, 0.90 to 1.17). It appeared more efficacious in the prevention of vascular events (RR, 0.90; 95% CI, 0.83 to 0.98), but this result only reached statistical significance because of 1 large trial in patients presenting with cerebral ischemia. Combination treatment of dipyridamole and aspirin compared with aspirin had an RR of 1.03 (95% CI, 0.87 to 1.22) for vascular death and an RR of 0.90 (95% CI, 0.80 to 1.00) for vascular events.
Conclusions:
For patients who presented with arterial vascular disease, there was no evidence that dipyridamole, in the presence or absence of another antiplatelet drug (chiefly aspirin), reduced the risk of vascular death, although it may reduce the risk of further vascular events. However, this benefit was found only in a single large trial and only in patients presenting after cerebral ischemia. There was no evidence that dipyridamole alone was more efficacious than aspirin. Further trials comparing the effects of the combination of dipyridamole plus aspirin with aspirin alone are justified.
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