This result was not influenced by the dose of dipyridamole or type of presenting vascular disease .
For patients who presented with arterial vascular disease , there was no evidence that dipyridamole , in the presence or absence of another antiplatelet drug reduced the risk of vascular death , though it reduces the risk of further vascular events .
This benefit was found only in patients presenting after cerebral ischaemia .
There was no evidence that dipyridamole alone was more efficacious than aspirin
BACKGROUND Patients with limited cerebral ischaemia of arterial origin are at risk of serious vascular events ( 4 % to 11 % annually ) .
Aspirin reduces that risk by 13 % .
In one trial , adding dipyridamole to aspirin was associated with a 22 % risk reduction compared with aspirin alone .
OBJECTIVES To assess the efficacy and safety of dipyridamole versus control in the secondary prevention of vascular events in patients with vascular disease .
Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial.
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 r and omised 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 infa rct ion , 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 St and ard R and omised Controlled Trial ( number IS RCT N73824458 ) 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 result ed in an overall risk ratio for the composite of vascular death , stroke , or myocardial infa rct ion 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
This result was not influenced by the dose of dipyridamole or type of presenting vascular disease .
For patients who presented with arterial vascular disease , there was no evidence that dipyridamole , in the presence or absence of another antiplatelet drug reduced the risk of vascular death , though it reduces the risk of further vascular events .
This benefit was found only in patients presenting after cerebral ischaemia .
There was no evidence that dipyridamole alone was more efficacious than aspirin
BACKGROUND Patients with limited cerebral ischaemia of arterial origin are at risk of serious vascular events ( 4 % to 11 % annually ) .
Aspirin reduces that risk by 13 % .
In one trial , adding dipyridamole to aspirin was associated with a 22 % risk reduction compared with aspirin alone .
OBJECTIVES To assess the efficacy and safety of dipyridamole versus control in the secondary prevention of vascular events in patients with vascular disease .