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To the Editor: In their summary statements of the evidence, Dr Straus and colleagues¹ sometimes failed to clarify the findings of single, groundbreaking randomized clinical trials, which may be more important than meta-analyses of multiple smaller studies. An example is their passing mention of the European Secondary Prevention Study 2 (ESPS-2), the largest study of aspirin and dipyridamole in secondary stroke prevention.²

Straus et al cited 4 studies (references 75-78) as providing information on the secondary prevention of stroke in patients with atrial fibrillation. Secondary prevention should denote treatment of patients who have already had a stroke or transient ischemic attack (TIA). In fact, only 1 of the 4 articles (ie, the European Atrial Fibrillation Trial) concerns secondary stroke prevention in atrial fibrillation. ESPS-2 had little to do with atrial fibrillation. The third citation is a chapter from a book that concerns patients with "no previous history of stroke or . . . [Full Text of this Article]

Howard S. Kirshner, MD
Stroke Center
Vanderbilt University
Nashville, Tenn

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