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To the Editor: Dr Straus and colleagues¹ stated that "the Antiplatelet Trialists' Collaboration [ATC]² did not find that adding dipyridamole to aspirin resulted in significant benefit over the use of aspirin alone, but they noted that a single randomized trial found that the addition of extended-release dipyridamole to aspirin decreased the risk of death significantly." The ATC authors claimed that the results of this "single randomized trial" (ESPS-2),³ which demonstrated significant reduction in stroke risk, was inconsistent with preceding negative trials of dipyridamole plus aspirin for cardiovascular disease prevention and that its results may have arisen "largely or wholly by the play of chance."²

In fact, ESPS-2 was the only prospective, multicenter randomized trial that was adequately designed (2 x 2 factorial analysis) and adequately powered to determine the independent and additive efficacy of aspirin and (extended-release) dipyridamole. The number of patients and vascular events (including strokes) in ESPS-2 exceeded . . . [Full Text of this Article]

James M. Gebel, MD
Department of Neurology
University of Pittsburgh Medical Center
Pittsburgh, Pa

Louis R. Caplan, MD
Department of Neurology
Beth Israel Medical Center
Boston, Mass

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