[Controversy on platelet-inhibiting drugs]

The only well established, clinically useful platelet inhibiting drug is aspirin, though the optimal dose is unknown. Experimental findings, the virtual absence of side effects and, so far, four clinical studies favour a dose of 100-300 mg per day. The majority of clinical studies, however, and particularly those involving patients with cerebrovascular diseases, have employed doses of aspirin of 1000-1200 mg per day. Aspirin reduces mortality and infarction rates in patients who have already had myocardial infarction by 0-30%. The efficacy of additional dipyridamol or of sulfinpyrazone is not proven either. So far the effects of aspirin in patients with unstable angina and in patients after aortocoronary bypass surgery are more favourable. The best evidenced indication for aspirin treatment is transient ischemic attacks and status post stroke. The beneficial effect of aspirin in these conditions may also extend to women. Additional dipyridamol is also useless in this condition.