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To the Editor: We are concerned about some of the recommendations in the Clinical Review of oral antiplatelet agents by Drs Tran and Anand¹ that we believe are inconsistent with clinical trial data and current clinical practice guidelines. First, the use of combined aspirin and extended-release dipyridamole (ASA-ERDP) in patients with concomitant symptomatic CAD is described as questionable, due to a theoretical risk of coronary steal. The European Stroke Prevention Study 2 trial of ASA-ERDP² included more than 2000 patients with TIA or stroke and with coexisting CAD. No safety problems with ERDP were noted in this population, and the 18% relative benefit of ASA-ERDP over aspirin alone for prevention of stroke in this subgroup was consistent with that observed in the overall trial³ ; patients with cerebrovascular disease and a history of CAD who were treated with ASA-ERDP had no increase in the risk of cardiac events compared with . . . [Full Text of this Article]

Richard A. Bernstein, MD, PhD
r-bernstein@northwestern.edu
Davee Department of Neurology
Feinberg School of Medicine of Northwestern University
Chicago, Ill

Gregory W. Albers, MD
Department of Neurology
Stanford University
Palo Alto, Calif

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