Anti-platelet for Secondary Stroke Prevention


Clopidrogel better than ASA for decreasing the cumulative risk of Ischemic Stroke, MI, or Vascular Death

ASA + Dypridamole better than either alone for stroke, death and stroke combined. However, overall mortality was not different

Conclusion: 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


Prior to this study we knew ASA+ER Dipyridamole was better than ASA alone (ESPS2 , ESPRIT). We also knew Clopidogrel is better than ASA alone (CAPRIE). We knew Clopidogrel + ASA is not better than ASA alone (CHARISMA).  But, we did not know if Clopidogrel is better than ASA-ERDP. 
PRoFESS answered that. None is superior to other regimen. 
At least, from the study thus far, either ASA-ERDP or Clopidogrel is the treatment of choice. ASA alone while dose work (ATTC) should be less preferred. 
However, PRoFESS was a non-inferiority trial, and the fact that hypothesis was not proved one could argue it is inferior. Hence, please read this editorial (NEJM Editorial 2008) for better clarification. 


In patients with recent Lacunar Stroke, ASA+Clopidogrel is not better to ASA alone. It however, increased the risk of bleeding. Conclusion from this study, further supports the finding of CHARISMA 2008. 

Based on these data, no role of DAPT in lacunar stroke. However, despite the lack of evidence, one could argue the benefit of DAPT in Large artery atherosclerotic disease (no study in such population so far)