What is the recommended duration of therapy with aspirin and dipyridamole (Persantine) after a cerebrovascular accident (CVA) or stroke?

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Dainyal Siddiqui, MD

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Manuel Jimenez, MD

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: March 17, 2025 • View editorial policy

From the Guidelines

After a cerebrovascular accident (CVA) or stroke, the recommended duration of therapy with aspirin and dipyridamole (Persantine) is at least 1-2 years, though many patients remain on this therapy indefinitely depending on their individual risk factors. The typical dosage is one capsule (25mg aspirin/200mg extended-release dipyridamole) taken twice daily, morning and evening. This dual antiplatelet therapy works by preventing blood clots through two different mechanisms: aspirin blocks an enzyme called cyclooxygenase, reducing production of thromboxane A2 which normally promotes platelet clumping, while dipyridamole increases cyclic adenosine monophosphate (cAMP) levels in platelets, further inhibiting their ability to stick together 1.

The decision to continue or discontinue this medication should always be made in consultation with your healthcare provider, as they will consider your specific stroke type, risk of recurrence, bleeding risk, and other medical conditions. Some patients may be switched to a different antiplatelet regimen based on their response or side effects. While taking this medication, it's essential to report any unusual bleeding or bruising to your doctor immediately. According to the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack, antiplatelet therapy is indicated in preference to oral anticoagulation to reduce the risk of recurrent ischemic stroke and other cardiovascular events while minimizing the risk of bleeding 1.

Key considerations for the duration of therapy include:

  • The risk of recurrent stroke and other cardiovascular events
  • The risk of bleeding complications, such as intracranial hemorrhage (ICH) and major bleeding
  • The patient's individual risk factors, such as age, stroke severity, and comorbidities
  • The potential benefits and harms of continuing or discontinuing antiplatelet therapy 2, 3.

It's crucial to weigh these factors and make an informed decision with your healthcare provider to determine the optimal duration of therapy with aspirin and dipyridamole for your specific situation.

From the Research

The recommended duration of therapy with aspirin and dipyridamole (Persantine) after a cerebrovascular accident (CVA) or stroke is not explicitly stated in the provided studies. However, the studies suggest the following:

  • Aspirin alone (50-325 mg/d), a combination of aspirin (25 mg) plus extended-release dipyridamole (200 mg), given twice daily, or clopidogrel (75 mg/d) may be used as initial treatment for preventing recurrent stroke 4.
  • The combination of aspirin plus extended-release dipyridamole is more efficacious than low-dose aspirin alone in preventing recurrent stroke 4, 5.
  • The American College of Chest Physicians recommends treatment with an antiplatelet agent, including aspirin (50-100 mg/d), the combination of aspirin and extended-release dipyridamole (25 mg/200 mg bid), or clopidogrel (75 mg qd) for long-term stroke prevention in patients with noncardioembolic stroke or transient ischemic attack (TIA) 6.

Key Considerations

Some key considerations for the use of aspirin and dipyridamole in the secondary prevention of stroke include:

  • The combination of aspirin and extended-release dipyridamole has shown superiority to aspirin alone in the secondary prevention of stroke 5, 7.
  • Clopidogrel has shown superiority over aspirin in the combined endpoints of stroke, death, and myocardial infarction 7.
  • The use of triple antiplatelet therapy (aspirin, clopidogrel, and dipyridamole) may be associated with a significant increase in adverse events and bleeding rates, and their severity 8.

Antiplatelet Agents

The following antiplatelet agents are commonly used in the secondary prevention of stroke:

  • Aspirin (50-325 mg/d)
  • Combination of aspirin (25 mg) plus extended-release dipyridamole (200 mg), given twice daily
  • Clopidogrel (75 mg/d)
  • The combination of aspirin and clopidogrel is not recommended for most patients with previous stroke or TIA, due to the increased risk of bleeding 5, 6.

References

4
Research

Antiplatelet therapy for prevention of recurrent stroke.

Current treatment options in neurology, 2009

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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