Aggrenox^© (ASS+Dipyridamol) nach Schlaganfall besser als ASS 100 mg?

Zusammenfassung

Einführung: Seit Jahren wird die Wertigkeit der Kombination Dipyridamol+ASS im Vergleich zur Standardtherapie ASS in der Sekundärprävention nach Schlaganfall kontrovers beurteilt. Anhand der sich aktuell veränderten Studienlage wird hier der Einsatz in der hausärztlichen Versorgung diskutiert.

Methode: Literaturrecherche und Analyse der vorliegenden Studien.

Ergebnisse: Es liegen 5 doppelblinde RCT mit gegensätzlichen Ergebnissen bei unterschiedlichen Dosierungen vor. Kürzlich wurde eine unverblindete RCT (ESPRIT) vorgelegt, die einen Benefit der Kombination vs. ASS zu bestätigen scheint. Bei dieser Studie sind aber designbedingte Verzerrungen nicht auszuschließen.

Schlussfolgerung: Der wissenschaftliche Nachweis einer Überlegenheit der Kombination Dipyridamol+ASS steht weiterhin aus. Bei schlechterer Verträglichkeit fehlt derzeit die Grundlage für eine Firstline-Empfehlung in der hausärztlichen Versorgung.

Abstract

Introduction: For years now opinions habe been divided as to the effectiveness of a combination of Dipyramidol+ASS as compared to the standard ASS treatment. In this paper, its use for secondary prevention of stroke in general practices is reviewed in the light of recent clinical trials.

Method: Systematic search and analysis of studies on this subject.

Findings: There are 5 doubleblinded RTCs showing contradictory results at different dosages. Another unblinded RTC (ESPRIT) - though possibly biased - shows an advantage of the combination over ASS.

Conclusion: There is still no sufficient evidence of the superiority of the combination. In view of lower drug compatibility its use as a first line line drug cannot be recommended for general practice.

Dipyridamol+ASS - Schlaganfall - hausärztliche Versorgung

Dipyridamole+aspirin - stroke - primary care

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