Is aspirin effective for primary stroke prevention?
Aspirin is not effective for primary stroke prevention. It is moderately effective at reducing the risk of recurrent thrombotic stroke. • What about aspirin plus extended-release dipyridamole to prevent stroke recurrence? The European Stroke Prevention Study-2 demonstrated that ASA/ER-DP significantly reduced the risk of recurrent stroke (ASA 50 mg/day; ER-DP 400 mg/day). The most recent ACCP guideline, citing the lack of a clear risk-benefit ratio despite a high-quality study, makes an intermediate-strength recommendation (Grade 2A) favoring ASA/ER-DP over aspirin alone to prevent recurrent stroke after a TIA or noncardioembolic stroke. • Does clopidogrel prevent stroke recurrence? Two randomized trials have tested the effectiveness of clopidogrel to prevent secondary stroke in a group of patients with a prior stroke or TIA. The Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial compared clopidogrel with aspirin in patients with a stroke, a recent MI, or
