Dipyridamole‐induced headache and lower recurrence risk in secondary prevention of ischaemic stroke: a post hoc analysis. (8th July 2014)

• Record Type: Journal Article
• Authors: Davidai, G.; Cotton, D.; Gorelick, P.; Bath, P. M. W.; Lipton, R. B.; Sacco, R.; Diener, H.‐C.
• Is Part Of: European journal of neurology. Volume 21:Number 10(2014:Oct.)
• Page Start: 1311
• Page End: 1317
• Publication Date: 2014-07-08
• Subjects: Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.12484
• Languages: English
• ISSNs: 1351-5101

Abstract

<abstract abstract-type="main" id="ene12484-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ene12484-sec-0001" sec-type="section"> <title>Background and purpose</title> <p>Our objective was to investigate the association between recurrent stroke risk and headache induced by extended‐release dipyridamole (ER‐DP) when administered alone or with low‐dose aspirin (ASA+ER‐DP).</p> </sec> <sec id="ene12484-sec-0002" sec-type="section"> <title>Methods</title> <p>This was a <italic>post hoc</italic> analysis of prospectively collected data on recurrent stroke risk and headache as an adverse event or reason for treatment discontinuation from the PRoFESS (<italic>N </italic>=<italic> </italic>20 332) and ESPS2 (<italic>N </italic>=<italic> </italic>6602) trials. Hazard ratios (HRs) for recurrent stroke were calculated using the Cox model.</p> </sec> <sec id="ene12484-sec-0003" sec-type="section"> <title>Results</title> <p>In PRoFESS, the 2.5‐year recurrent stroke risk in patients receiving ASA+ER‐DP was 8.2% in those with headache within 7 days of starting treatment and 9.4% in those without [HR 0.85, 95% confidence interval (CI) 0.73–0.98; <italic>P </italic>=<italic> </italic>0.03]. Recurrent stroke risk was 5.0% in patients who discontinued ASA+ER‐DP due to headache by day 90 versus 9.2% in those who did not (HR 0.52, 95% CI 0.35–0.77; <italic>P </italic>=<italic> </italic>0.001). No such difference was observed in clopidogrel‐treated patients. In ESPS2, risk of recurrent stroke was 6.2% in patients who discontinued ASA+ER‐DP due to headache by day 90 versus 9.8% in patients who did not (HR 0.62, 95% CI 0.31–1.27; <italic>P </italic>=<italic> </italic>0.19) and 7.3% in patients who discontinued ER‐DP due to headache by day 90 versus 13.2% in those who did not (HR 0.53, 95% CI 0.27–1.04; <italic>P </italic>=<italic> </italic>0.06).</p> </sec> <sec id="ene12484-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Patients taking ASA+ER‐DP in PRoFESS who developed headache had significantly reduced stroke recurrence risk versus those without headache. Similar (non‐significant) findings for ASA+ER‐DP and ER‐DP in ESPS2 suggest that dipyridamole‐induced headache may reflect better cerebrovascular function.</p> </sec> </abstract>