JOURNAL OF THE
NEUROLOGICAL SCIENCES
ELSEVIER
Jouinal of Neuiological Sciences 150 (1997) 85Lettei to the Editor
Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke
F R RosendaaT % A Algra
0Umvusity Hospital Luden Leiden The Netheilanch
bUniveisity Hospital Unecht Unecht The Netheilands
Received 19 Decembei 1996 accepted 17 Febiuaiy 1997
Sn,
With mterest we read the report on the ESPS 2 tnal (Diener et a l , 1996), in which dipyndamole appeaied effective when added to aspirin in the secondary pieven üon after ceiebral ischemia These results are remarkable, since they are at vanance to a laige body of evidence that points to no effect of the combmation dipyndamole and aspiim m companson to aspirin only, regardless of the mdication (Antiplatelet Tuahsts' Collaboiation, 1994, Can negieter et al, 1994) From the report we undei stand that a number of patients were excluded fiom the analysis because of major protocol deviations This conceined the considerable number of 452 patients, amounting up to 6 4% of the total number of patients randomized Since, although possibly defendable, this constitutes a depaiture fiom the mtention-to-treat pnnciple, we think it important to know if outcome event data aie available on these
patients, and if the results on this large group that was deleted from the published analysis were different fiom the published results, i e , was a sirmlai effect of dipyndamole plus aspnin found an exaggerated effect, or no effect17
References
Antiplatelet Tuahsts Collaboiation (1994) Collaboiative overveiw of landomized tnals of antiplatelet theiapy I Pievention of death myocaidial mfarction and stioke by piolonged anti platelet Iheiapy in vanous categones of patients Bi J Med 308 81 106
Cannegietei SC Rosendaal FR and Briet E (1994) Thiomboembohc and bleeding complications in patients with mechanical heait valve piostheses Circulation 89 635-641
Dienei H C Cunha L Foibes C Sivenius J Smets P and Lowenth al A (1996) European Stroke Prevention Study 2 Dipyndamole and acetylsalicylic acid in the secondary pievention of stioke J Neurol Sei 143 1-13
Conespondmg authoi Umveisity Hospital Leiden PO Box 9600 2300 RC Leiden The Netheilands
0022 510X/97/S1700 © 1997 Eisevier Science BV All nghts leseived
