ESPRIT trial.

摘要

The finding by the ESPRIT Study Group (May 20, p 1665)1 of a 30% reduction in major bleeding among patients treated with aspirin and dipyridamole compared with aspirin alone raises two important questions.First, what is the mechanism of reduced bleeding in patients treated with aspirin and dipyridamole? Several hypotheses can be proposed. (1) More patients randomised to open-label aspirin and dipyridamole than aspirin alone might have been treated with acid-suppressive therapy (eg, proton-pump inhibitors) to prevent or treat gastrointestinal symptoms caused by dipyridamole, thereby reducing the risk of gastrointestinal bleeding. (2) More patients assigned to aspirin alone than to aspirin and dipyridamole might have undergone cardiac procedures because cardiac events were more common in patients treated with aspirin alone. Cardiac interventions are a common cause of bleeding and haemorrhagic stroke.(3) A greater proportion of intracranial haemorrhage might have been secondary haemorrhagic transformationof ischaemic stroke in patients assigned aspirin alone compared with patients assigned aspirin and dipyridamole, becauseischaemic strokes were more common in patients treated with aspirin alone.