Dipyridamole-induced headache and lower recurrence risk in secondary prevention of ischaemic stroke: A post hoc analysis

G. Davidai, D. Cotton, P. Gorelick, P. M W Bath, R. B. Lipton, Ralph L Sacco, H. C. Diener

Research output: Contribution to journalArticle

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Abstract

Background and purpose: Our objective was to investigate the association between recurrent stroke risk and headache induced by extended-release dipyridamole (ER-DP) when administered alone or with low-dose aspirin (ASA+ER-DP). Methods: This was a post hoc analysis of prospectively collected data on recurrent stroke risk and headache as an adverse event or reason for treatment discontinuation from the PRoFESS (N = 20 332) and ESPS2 (N = 6602) trials. Hazard ratios (HRs) for recurrent stroke were calculated using the Cox model. Results: In PRoFESS, the 2.5-year recurrent stroke risk in patients receiving ASA+ER-DP was 8.2% in those with headache within 7 days of starting treatment and 9.4% in those without [HR 0.85, 95% confidence interval (CI) 0.73-0.98; P = 0.03]. Recurrent stroke risk was 5.0% in patients who discontinued ASA+ER-DP due to headache by day 90 versus 9.2% in those who did not (HR 0.52, 95% CI 0.35-0.77; P = 0.001). No such difference was observed in clopidogrel-treated patients. In ESPS2, risk of recurrent stroke was 6.2% in patients who discontinued ASA+ER-DP due to headache by day 90 versus 9.8% in patients who did not (HR 0.62, 95% CI 0.31-1.27; P = 0.19) and 7.3% in patients who discontinued ER-DP due to headache by day 90 versus 13.2% in those who did not (HR 0.53, 95% CI 0.27-1.04; P = 0.06). Conclusions: Patients taking ASA+ER-DP in PRoFESS who developed headache had significantly reduced stroke recurrence risk versus those without headache. Similar (non-significant) findings for ASA+ER-DP and ER-DP in ESPS2 suggest that dipyridamole-induced headache may reflect better cerebrovascular function.

Original languageEnglish
Pages (from-to)1311-1317
Number of pages7
JournalEuropean Journal of Neurology
Volume21
Issue number10
DOIs
StatePublished - Jan 1 2014

Fingerprint

Dipyridamole
Secondary Prevention
Headache
Stroke
Recurrence
Confidence Intervals
clopidogrel
Proportional Hazards Models

Keywords

  • Cerebrovascular disease
  • Dipyridamole
  • Headache
  • Intracerebral hemorrhage
  • Stroke
  • Stroke prevention

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Dipyridamole-induced headache and lower recurrence risk in secondary prevention of ischaemic stroke : A post hoc analysis. / Davidai, G.; Cotton, D.; Gorelick, P.; Bath, P. M W; Lipton, R. B.; Sacco, Ralph L; Diener, H. C.

In: European Journal of Neurology, Vol. 21, No. 10, 01.01.2014, p. 1311-1317.

Research output: Contribution to journalArticle

Davidai, G. ; Cotton, D. ; Gorelick, P. ; Bath, P. M W ; Lipton, R. B. ; Sacco, Ralph L ; Diener, H. C. / Dipyridamole-induced headache and lower recurrence risk in secondary prevention of ischaemic stroke : A post hoc analysis. In: European Journal of Neurology. 2014 ; Vol. 21, No. 10. pp. 1311-1317.
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abstract = "Background and purpose: Our objective was to investigate the association between recurrent stroke risk and headache induced by extended-release dipyridamole (ER-DP) when administered alone or with low-dose aspirin (ASA+ER-DP). Methods: This was a post hoc analysis of prospectively collected data on recurrent stroke risk and headache as an adverse event or reason for treatment discontinuation from the PRoFESS (N = 20 332) and ESPS2 (N = 6602) trials. Hazard ratios (HRs) for recurrent stroke were calculated using the Cox model. Results: In PRoFESS, the 2.5-year recurrent stroke risk in patients receiving ASA+ER-DP was 8.2{\%} in those with headache within 7 days of starting treatment and 9.4{\%} in those without [HR 0.85, 95{\%} confidence interval (CI) 0.73-0.98; P = 0.03]. Recurrent stroke risk was 5.0{\%} in patients who discontinued ASA+ER-DP due to headache by day 90 versus 9.2{\%} in those who did not (HR 0.52, 95{\%} CI 0.35-0.77; P = 0.001). No such difference was observed in clopidogrel-treated patients. In ESPS2, risk of recurrent stroke was 6.2{\%} in patients who discontinued ASA+ER-DP due to headache by day 90 versus 9.8{\%} in patients who did not (HR 0.62, 95{\%} CI 0.31-1.27; P = 0.19) and 7.3{\%} in patients who discontinued ER-DP due to headache by day 90 versus 13.2{\%} in those who did not (HR 0.53, 95{\%} CI 0.27-1.04; P = 0.06). Conclusions: Patients taking ASA+ER-DP in PRoFESS who developed headache had significantly reduced stroke recurrence risk versus those without headache. Similar (non-significant) findings for ASA+ER-DP and ER-DP in ESPS2 suggest that dipyridamole-induced headache may reflect better cerebrovascular function.",
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T2 - A post hoc analysis

AU - Davidai, G.

AU - Cotton, D.

AU - Gorelick, P.

AU - Bath, P. M W

AU - Lipton, R. B.

AU - Sacco, Ralph L

AU - Diener, H. C.

PY - 2014/1/1

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N2 - Background and purpose: Our objective was to investigate the association between recurrent stroke risk and headache induced by extended-release dipyridamole (ER-DP) when administered alone or with low-dose aspirin (ASA+ER-DP). Methods: This was a post hoc analysis of prospectively collected data on recurrent stroke risk and headache as an adverse event or reason for treatment discontinuation from the PRoFESS (N = 20 332) and ESPS2 (N = 6602) trials. Hazard ratios (HRs) for recurrent stroke were calculated using the Cox model. Results: In PRoFESS, the 2.5-year recurrent stroke risk in patients receiving ASA+ER-DP was 8.2% in those with headache within 7 days of starting treatment and 9.4% in those without [HR 0.85, 95% confidence interval (CI) 0.73-0.98; P = 0.03]. Recurrent stroke risk was 5.0% in patients who discontinued ASA+ER-DP due to headache by day 90 versus 9.2% in those who did not (HR 0.52, 95% CI 0.35-0.77; P = 0.001). No such difference was observed in clopidogrel-treated patients. In ESPS2, risk of recurrent stroke was 6.2% in patients who discontinued ASA+ER-DP due to headache by day 90 versus 9.8% in patients who did not (HR 0.62, 95% CI 0.31-1.27; P = 0.19) and 7.3% in patients who discontinued ER-DP due to headache by day 90 versus 13.2% in those who did not (HR 0.53, 95% CI 0.27-1.04; P = 0.06). Conclusions: Patients taking ASA+ER-DP in PRoFESS who developed headache had significantly reduced stroke recurrence risk versus those without headache. Similar (non-significant) findings for ASA+ER-DP and ER-DP in ESPS2 suggest that dipyridamole-induced headache may reflect better cerebrovascular function.

AB - Background and purpose: Our objective was to investigate the association between recurrent stroke risk and headache induced by extended-release dipyridamole (ER-DP) when administered alone or with low-dose aspirin (ASA+ER-DP). Methods: This was a post hoc analysis of prospectively collected data on recurrent stroke risk and headache as an adverse event or reason for treatment discontinuation from the PRoFESS (N = 20 332) and ESPS2 (N = 6602) trials. Hazard ratios (HRs) for recurrent stroke were calculated using the Cox model. Results: In PRoFESS, the 2.5-year recurrent stroke risk in patients receiving ASA+ER-DP was 8.2% in those with headache within 7 days of starting treatment and 9.4% in those without [HR 0.85, 95% confidence interval (CI) 0.73-0.98; P = 0.03]. Recurrent stroke risk was 5.0% in patients who discontinued ASA+ER-DP due to headache by day 90 versus 9.2% in those who did not (HR 0.52, 95% CI 0.35-0.77; P = 0.001). No such difference was observed in clopidogrel-treated patients. In ESPS2, risk of recurrent stroke was 6.2% in patients who discontinued ASA+ER-DP due to headache by day 90 versus 9.8% in patients who did not (HR 0.62, 95% CI 0.31-1.27; P = 0.19) and 7.3% in patients who discontinued ER-DP due to headache by day 90 versus 13.2% in those who did not (HR 0.53, 95% CI 0.27-1.04; P = 0.06). Conclusions: Patients taking ASA+ER-DP in PRoFESS who developed headache had significantly reduced stroke recurrence risk versus those without headache. Similar (non-significant) findings for ASA+ER-DP and ER-DP in ESPS2 suggest that dipyridamole-induced headache may reflect better cerebrovascular function.

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KW - Dipyridamole

KW - Headache

KW - Intracerebral hemorrhage

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KW - Stroke prevention

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