Titrated Initiation of Acetylsalicylic Acid-Dipyridamole Therapy Reduces Adverse Effects and Improves Tolerance in Patients With Stroke

• Published in: Journal of stroke and cerebrovascular diseases Vol. 17; no. 6; pp. 356 - 359
• Main Authors: Douen, André G., MD, PhD, FRCPC, Medic, Sejla, RN, Sabih, Mehreen, MBBS, Pageau, Nicole, RN, BA, Shuaib, Ashfaq, MD, FRCPC, FAHA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2008
• Subjects: Adenosine - metabolism; Aged; aspirin; Aspirin - administration & dosage; Aspirin - adverse effects; Cardiovascular; Cerebral Arteries - drug effects; Cerebral Arteries - physiopathology; Cerebrovascular Circulation - drug effects; Cerebrovascular Circulation - physiology; dipyridamole; Dipyridamole - administration & dosage; Dipyridamole - adverse effects; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Synergism; Drug Therapy, Combination; Drug Tolerance - physiology; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; headache; Headache - chemically induced; Headache - physiopathology; Headache - prevention & control; Humans; Male; Migraine Disorders - complications; Migraine Disorders - physiopathology; Neurology; Phosphodiesterase Inhibitors - administration & dosage; Phosphodiesterase Inhibitors - adverse effects; Stroke; Stroke - drug therapy; Stroke - prevention & control; transient ischemic attack; Treatment Outcome; Vasodilation - drug effects; Vasodilation - physiology; aspirin; Stroke; transient ischemic attack; dipyridamole; headache
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2008.04.003

Background Standard aspirin (acetylsalicylic acid [ASA])-dipyridamole therapy twice daily is associated with high rates of discontinuation in large part because of headache and gastrointestinal side effects. Attempts to address dipyridamole-induced headache through reduced dose initiation have produced variable results. Moreover, it has been suggested that migraineurs are more likely to have a dipyridamole-induced headache. Objective We sought to evaluate whether titrated initiation of ASA-dipyridamole in patients with stroke/transient ischemic attack (TIA) improves tolerance and to assess the appearance of headache in those with pre-existing history of headaches. Methods ASA-dipyridamole (25/200 mg) once daily together with ASA (81 mg) daily was started in 130 patients given the diagnosis of stroke/TIA with instructions to increase ASA-dipyridamole to twice daily after 7 days and discontinue ASA (81 mg). Patients received a telephone call on days 7 and 14 to assess for adverse events, discontinuation, and recurrent stroke/TIA. Results Two patients were lost to follow-up. After 2 weeks, 113 patients were using the medication without any major complications. Fifteen patients were off therapy; 10 (8%) patients stopped because of headache and/or gastrointestinal symptoms, whereas 4 patients were switched to other antiplatelet agents by their primary care physician as a matter of choice rather than ASA-dipyridamole side effects. One patient had recurrent stroke because of intracranial dissection and was switched to anticoagulation. Only 4 of 27 (14%) patients with a history of headache discontinued therapy. Conclusions Titrated initiation of ASA-dipyridamole (25/200 mg) appears to have low discontinuation rate and ∼90% tolerance after 2 weeks. History of migraine or tension headaches was not directly associated with discontinuation because of headaches.