Dipyridamole, anticoagulant therapy

European Atrial Fibrillation Trial Study Group (1995). Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. New England Journal of Medicine 333 5-10 Halkes PH, van Gijn J For the ESPRIT Study Group (2006). Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT) randomised controlled trial. Lancet 367 1665-73 [Erratum in Lancet (2007) 369 274]... 

Pouleur H, Buyse M. Effects of dipyridamole in combination with anticoagulant therapy on survival and thromboembolic events in patients with prosthetic heart valves. A meta-analysis of the randomized trials. JTTiorac Cardiovasc Surg (1995) 110, 463—72. 

Apart from surgical and interventional therapy of occlusive carotid artery disease, the major approach to preventing vascular disease and subsequent stroke is to pay close attention to the control of modifiable risk factors such as hypertension, smoking, diabetes, and hypercholesterolemia. Coumadin, an anticoagulant, is effective for the primary and secondary prevention of stroke in patients with atrial fibrillation. Aspirin, clopidogrel, and the combination of aspirin and dipyridamole have been proven to be effective for secondary stroke prevention along with the antihypertensive combination of indap-amide and perindopril. 

Dipyridamole is indicated as an adjunct to therapy with cou-marin anticoagulant in the prevention of postoperative thromboembolic complications of cardiac valve replacement as an alternative to exercise in thaUium myocardial perfusion imaging for the evaluation of coronary artery disease in patients who are unable to exercise and in long-term therapy for angina pectoris. Dipyridamole inhibits platelet adhesion and is a coronary vasodilator. Inappropriate use of dipyridamole has caused MI, ventricular fibrillation, tachycardia, bronchospasm, and transient cerebral ischania (see also Figures 14 and 92). 

The treatment of patients with symptomatic intracranial atherosclerotic disease can be summarized into prevention of occurrence of intraluminal thrombosis, plaque stabilization, and control of risk factors for atherosclerosis. Anticoagulation (compared with aspirin) has not shown to be beneficial in patients with intracranial atherosclerotic disease [24]. Current guidelines recommend that aspirin alone, the combination of aspirin and extended release dipyridamole, and clopidogrel monotherapy (rather than oral anticoagulants) are aU acceptable options [24]. hi patients with hemodynamically sigifificant intracranial stenosis who have symptoms despite medical therapies (antithrombotics, statins, and other treatments for risk factors), the usefulness of endovascular therapy (angioplasty and/or stent placement) is uncertain and is considered investigational [22, 25],... 

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