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Understanding the PRoFESS Study for Secondary Stroke Prevention.

Michael J Schneck¹

¹Michael J. Schneck, MD Department of Neurology, Loyola University Medical Center, Maguire Building, Suite 2700, 2160 South First Avenue, Maywood, IL 60153, USA. mschneck@lumc.edu.

Current Treatment Options in Cardiovascular Medicine

|May 13, 2009

Summary

The large PRoFESS trial found no significant differences between extended-release dipyridamole plus aspirin (eDYP-ASA) and clopidogrel for preventing recurrent strokes. eDYP-ASA increased bleeding events, suggesting clopidogrel or eDYP-ASA are preferred over aspirin for secondary stroke prevention.

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Area of Science:

Neurology
Cardiovascular Medicine
Clinical Trials

Background:

Secondary stroke prevention is crucial for reducing morbidity and mortality.
The PRoFESS trial was the largest study to date investigating secondary stroke prevention strategies.
Previous antiplatelet therapies, including aspirin, have known bleeding risks.

Purpose of the Study:

To compare the efficacy and safety of extended-release dipyridamole plus aspirin (eDYP-ASA) versus clopidogrel in preventing recurrent strokes.
To evaluate telmisartan versus antihypertensive regimens excluding ARBs for stroke prevention.
To clarify the role of angiotensin receptor blockers (ARBs) in post-stroke care.

Main Methods:

A large-scale, randomized, controlled trial (PRoFESS) comparing eDYP-ASA with clopidogrel.
Comparison of telmisartan with other antihypertensive regimens, excluding ARBs.
Assessment of primary outcomes (fatal/nonfatal stroke) and secondary endpoints, including hemorrhagic events.

Main Results:

No statistical differences were observed between eDYP-ASA and clopidogrel for the primary outcome of stroke recurrence.
eDYP-ASA was associated with an increase in major hemorrhagic events compared to clopidogrel.
The role of ARBs in secondary stroke prevention remains unclear due to concomitant ACE inhibitor use.

Conclusions:

While eDYP-ASA and clopidogrel showed similar efficacy in preventing recurrent strokes, eDYP-ASA posed a higher bleeding risk.
Current evidence suggests clopidogrel or eDYP-ASA are preferred over aspirin for secondary stroke prevention due to a better benefit-risk profile.
Further research is needed to elucidate the specific role of ARBs in post-stroke management.