The practical implementation of current guidelines on stroke treatment and the growing evidence that dipyridamole has properties that distinguish it from other antiplatelet agents are among the contemporary issues discussed at an expert stroke physicians` satellite meeting of the 13th European Stroke Conference held in Mannheim, Germany, this year.

Current guidelines in both Europe (EUSI, European Stoke Initiative) and the USA (ACCP, American College of Chest Physicians) recommend extended-release dipyridamole + ASA (marketed as Aggrenox or Asasantin Retard) as a first-line treatment for secondary prevention of recurrent strokes after a stroke or transient ischaemic attack (TIA).

Further, preliminary recommendations on the secondary prevention of stroke from the National Institute for Clinical Excellence (NICE) in the UK recommend the use of the combination of aspirin and extended release dipyridamole (for 2 years), except in those who are intolerant of these drugs. Aided by interactive questioning of the audience about their own practices and views, Professor Werner Hacke, Head of the Neurology Department at the Rupprecht Karls University in Heidelberg, Germany, explained the discrepancy between the recommendations of current guidelines and daily practices both in secondary prevention of stroke and in its acute treatment.

The strong position of Aggrenox (extended-release dipyridamole + ASA) in current guidelines, based on evidence from large scale clinical trials, is increasingly supported by evidence that the mechanisms of dipyridamole, beyond antiplatelet activity, may merit its inclusion in a separate therapeutic class distinct from antiplatelet agents. Recent evidence, indicating that Aggrenox has anti-inflammatory properties independent of its effect on platelet aggregation, has been presented by Professor Stephen Prescott, University of Utah, Salt Lake City, USA.

Aggrenox/Asasantin is being investigated for its potential to prevent second strokes. The trial PRoFESS, the world`s largest study of comparative regimen in secondary stroke prevention is among the ongoing trials likely to influence future recommendations. PRoFESS (Prevention Regimen For Effectively avoiding Second Strokes), is designed to investigate the potential of Aggrenox/ Asasantin Retard (dipyridamole extended release + ASA) and Micardis (telmisartan) to prevent second strokes. Already, in excess of 1700 patients have been enrolled in the international PRoFESS trial, which compares Aggrenox/Asasantin Retard with the combination regimen of clopidogrel plus aspirin and will test the hypothesis of superiority over the antiplatelet regimen as well as the importance of Angiotensin II antagonism, in preventing second strokes.