A systematic review 1 including 6 studies with a total of 1 141 subjects was abstracted in DARE. The combination of dipyridamole and anticoagulants reduced the risk of thromboembolic events (fatal or nonfatal) by 56% (95% CI 33% to 71%) when compared to anticoagulants alone. The overall mortality rate was reduced by 40% (95% CI 10% to 60%) in the group receiving dipyridamole. However, for this end point, there was significant heterogeneity between trials, most of the benefit in terms of overall mortality coming from one trial, and includes a large perioperative mortality difference between groups which occurred before drug treatment started. The frequency of haemorrhagic events did not differ between treatment groups (risk reduction -1%, p=0.94).
Comment: The quality of evidence is downgraded by inconsistency of results and limitations of review methodology. The review offers no formal quality assessment of individual studies.
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