Abstract
Antiplatelet agents are the main group of drugs using for antiatherothrombotic prophylaxis and correction of microcirculatory disturbances in many fields of medicine. Dipyridamole in combination with acetylsalicylic acid is an important component of stroke prevention. It also demonstrates effectiveness for the prevention of cardiovascular complications due to its antiplatelet and vasodilatory effect. «Steal phenomenon» is a clinical exaggeration, because it happens only if high doses of dipyridamole are injected intravenously. Dipyridamole has numerous pleiotropic effects related with its ability to induce interferon synthesis, to regulate oxidative stress, activity of immune cells, matrix metalloproteinases, etc. Understanding of pathogenesis of numerous diseases as the interrelationship between hemostasis and inflammation may lead medical specialists to use dipyridamole in rheumatology, obstetrics, gynecology, nephrology, haematology and other fields of medicine and medical researches. High safety of dipyridamole in regard to hemorrhagic complications, malignant progression and its high economic accessibility are very important features of this well-known for clinicians drug. Further search of clinical applications for dipyridamole is discussed in this review.
REFERENCES
1. Mazurov A.V. Physiology and pathology of platelets. [Fiziologiya i patologiya trombocitov]. Moskva: Litterra, 2011. 480 s (in Russ.). 2. Kuznik B.I., Tsybikov N.N. Interrelation between immunogenesis and the hemostasis system: a common system of body protection. [Vzaimosvyaz’ mezhdu immunogenezom i sistemoj gemostaza: edi- naya sistema zashchity organizma]. Uspekhi sovremennoj biologii.
1981;92(2):243–60 (in Russ.).
3. Kuznik B.I. Cellular and molecular mechanisms of regulation of
the hemostatic system in health and disease: monograph. [Kletoch- nye i molekulyarnye mekhanizmy regulyacii sistemy gemostaza v norme i patologii: monografiya]. Chita: Ekspress-izdatel’stvo, 2010. 832 s (in Russ.).
4. Foulds T., Mackinnon J. Controlled double-blind trial of “persan- tin” in treatment of angina pectoris. Br Med J. 1960;2(5202):835–8. 5. Chakrabarti S., Freedman J.E. Dipyridamole, cerebrovascular dis- ease, and the vasculature. Vascul Pharmacol. 2008;48(4–6):143–9. 6. Tairova R.T. Features of pharmacological action and the use of di- pyridamole for secondary prevention of ischemic stroke. [Osoben- nosti farmakologicheskogo dejstviya i primeneniya dipiridamola dlya vtorichnoj profilaktiki ishemicheskogo insul’ta]. Consilium
Medicum. 2017;(2.3):15–8 (in Russ.).
7. Kim H.H., Liao J.K. Translational therapeutics of dipyridamole.
Arterioscler Thromb Vasc Biol. 2008;28(3):S39–42.
8. Yip S., Benavente O. Antiplatelet agents for stroke prevention. Neu-
rotherapeutics. 2011;8(3):475–87.
9. Wu C.C., Ko F.N., Teng C.M. Inhibition of platelet adhesion to col-
lagen by cGMP-elevating agents. Biochem Biophys Res Commun.
1997;231(2):412–6.
10. Tanashyan M.M., Raskurazhev A.A., Shabalina A.A., Roit-
man E.V. Cerebrovascular diseases: hemostasis and biomarkers. [Cerebrovaskulyarnye zabolevaniya: gemostaz i biomarkery]. Trom- boz, gemostaz i reologiya. 2018;(3):41–6 (in Russ.).
11. Muravyov A.V., Roitman E.V., Levin V.N. et al. Rheological prop- erties changes in patients with cerebrovascular diseases after pent- oxifylline therapy. [Izmenenie reologicheskih svojstv krovi u lic s cerebral’nym aterosklerozom v usloviyah lekarstvennoj terapii pentoksifillinom]. Tromboz, gemostaz i reologiya. 2010;(2):28–33 (in Russ.).
12. D’Esterre C.D., Tichauer K.M., Aviv R.I. et al. Dipyridamole treat- ment prior to stroke onset: examining post-stroke cerebral circula- tion and outcome in rabbits. Transl Stroke Res. 2011;2(2):186–94.
13. Melani A., Cipriani S., Corti F., Pedata F. Effect of intravenous ad- ministration of dipyridamole in a rat model of chronic cerebral ischemia. Ann NY Acad Sci. 2010;1207:89–96.
14. The ESPS2 Group. European Stroke Prevention Study 2: efficacy and safety data. J Neurol Sci. 1997;151(Suppl):S1–S77.
15. Halkes P.H., van Gijn J., Kappelle L.J. et al. ESPRIT Study Group. Aspirin plus dipyridamole versus aspirin alone after cerebral isch- emia of arterial origin (ESPRIT): randomized controlled trial. Lan- cet. 2006; 367(9523):1665–73.
16. Verro P., Gorelick P.B., Nguyen D. Aspirin plus dipyridamole ver- sus aspirin for prevention of vascular events after stroke or TIA: a meta-analysis. Stroke. 2008;39(4):1358–63.
17. Halkes P.H., Gray L.J., Bath P.M. et al. Dipyridamole plus as- pirin versus aspirin alone in secondary prevention after TIA or stroke: a meta-analysis by risk. J Neurol Neurosurg Psychiatry. 2008;79(11):1218–23.
18. Held V.E., Wolf M.E., Hennerici M.G. Antithrombotic ther- apy in transient ischemic attack patients. Front Neurol Neurosci. 2014;33:147–61.
19. Greenhalgh J., Bagust A., Boland A. et al. Clopidogrel and modified- release dipyridamole for the prevention of occlusive vascular events (review of Technology Appraisal No. 90): a systematic review and economic analysis. Health Technol Assess. 2011;15(31):1–178.
20. Sacco R.L. Aspirin plus extended-release dipyridamole and clopi- dogrel were similarly effective for preventing recurrent stroke. Evid Based Med. 2009;14(2):46–7.
21. Crown N., Mysak T. Safety of fixed-dose aspirin-extended-release dipyridamole in patients with ischemic heart disease. Am J Health Syst Pharm. 2010;67(9):728–33.
22. Li X., Zhou G., Zhou X., Zhou S. The efficacy and safety of aspirin plus dipyridamole versus aspirin in secondary prevention follow- ing TIA or stroke: a meta-analysis of randomized controlled trials. J Neurol Sci. 2013;332(1–2):92–6.
23. Sacco R.L., Sivenius J., Diener H.C. Efficacy of aspirin plus extended-release dipyridamole in preventing recurrent stroke in high-risk populations. Arch Neurol. 2005;62(3):403–8.
24. Baryshnikova G.A. Dipyridamole in general therapeutic practice. [Dipiridamol v obshcheterapevticheskoj praktike]. Problemy zhen- skogo zdorov’ya. 2007;1(2):88–97 (in Russ.).
25. Stakhovskaya L.V., Skvortsova V.I., Chazova I.E. Secondary pre- vention of an ischemic stroke. [Vtorichnaya profilaktika ishemi- cheskogo insul’ta]. Consilium Medicum. 2003;5(8):473–6 (in Russ.).
26. Domashenko M.A., Maksimova M. Yu., Tanashyan M.M. Antiplate- let therapy for secondary prevention of noncardioembolic ischemic stroke: a critical review. [Sovremennyj vzglyad na naznachenie an- tiagregantnyh preparatov dlya vtorichnoj profilaktiki nekardioem- bolicheskogo ishemicheskogo insul’ta]. Effektivnaya farmakotera- piya. 2018;(24):82–6 (in Russ.).
27. Khapiy I. Kh., Asymbekova E.U., Matskeplishvili S.T. Effect of dipyridamole on the content of vascular growth factors and the functional state of the myocardium in patients with stable angina. [Vliyanie dipiridamola na soderzhanie sosudistyh faktorov rosta i funkcional’noe sostoyanie miokarda u bol’nyh stabil’noj steno- kardiej]. Effektivnaya farmakoterapiya. 2010;(1):30–5 (in Russ.).
28. Gurevich K.G., Lobanova E.G. Biochemical pharmacology of dipyr- idamole, clinical application. [Biohimicheskaya farmakologiya dip- iridamola, klinicheskoe primenenie]. Kardiologiya. 2000;42(12):87– 91 (in Russ.).
29. Eeckhout E., Kern M.J. The coronary no-reflow phenomenon: a review of mechanisms and therapies. Eur Heart J. 2001;22:729–39. 30. Tanzilli G., Greco C., Pasceri V. et al. Dipyridamole versus vera- pamil for treatment of no-reflow during primary angioplasty. Cath-
eter Cardiovasc Interv. 2010;76(6):787–93.
31. Ikeda E., Kasai T., Kajimoto K. et al. Dipyridamole therapy im-
proves long-term survival after complete revascularization in pa- tients with impaired cardiac function: a propensity analysis. Circ J. 2008;72(10):1588–93.
32. Weyrich A.S., Skalabrin E.J., Kraiss L.W. Targeting the inflam- matory response in secondary stroke prevention: a role for com- bining aspirin and extended-release dipyridamole. Am J Ther. 2009;16(2):164–70.
33. Pattillo C.B., Bir S.C., Branch B.G. et al. Dipyridamole reverses pe- ripheral ischemia and induces angiogenesis in the Db/Db diabetic mouse hind-limb model by decreasing oxidative stress. Free Radic Biol Med. 2011;50(2):262–9.
34. Venkatesh P.K., Pattillo C.B., Branch B. et al. Dipyridamole enhances ischaemia-induced arteriogenesis through an endocrine nitrite/ nitricoxide-dependent pathway. Cardiovasc Res. 2010;85:661–70.
35. De Schryver E.L., Algra A., van Gijn J. Dipyridamole for prevent- ing stroke and other vascular events in patients with vascular dis- ease. Cochrane Database Syst Rev. 2006;(2):CD001820.
36. Baranov A.P., Kirichenko A.A., Buzin A.G. et al. High doses of di- pyridamole in lower limb arteriosclerosis obliterans. [Effektivnost’ vysokih doz kurantila pri obliteriruyushchih zabolevaniyah ar- terij nizhnih konechnostej]. Angiologiya i sosudistaya hirurgiya. 1999;5(3):93–8 (in Russ.).
37. Khajehdehi P., Roozbeh J., Mostafavi H. A comparative random- ized and placebo-controlled short-term trial of aspirin and di- pyridamole for overt type-2 diabetic nephropathy. Scand J Urol Nephrol. 2002;36(2):145–8.
38. Aizawa T., Suzuki S., Asawa T. et al. Dipyridamole reduces urinary albumin excretion in diabetic patients with normo- or microalbu- minuria. Clin Nephrol. 1990;33(3):130–5.
39. Hopper A.H., Tindall H., Davies J.A. Administration of aspirin–di- pyridamole reduces proteinuria in diabetic nephropathy. Nephrol Dial Transplant. 1989;4(2):140–3.
40. Sharma A.K., Khanna D., Balakumar P. Low-dose dipyridam- ole treatment partially prevents diabetes mellitus-induced vas- cular endothelial and renal abnormalities in rats. Int J Car- diol. 2014;172(2):530–2.
41. Weyrich A.S., Denis M.M., Kuhlmann-Eyre J.R. et al. Dipyridam- ole selectively inhibits inflammatory gene expression in platelet- monocyte aggregates. Circulation. 2005;111(5):633–42.
42. Massaro M., Scoditti E., Carluccio M.A. et al. Dipyridamole de- creases inflammatory metalloproteinase-9 expression and release by human monocytes. Thromb Haemost. 2013;109(2):280–9.
43. Gomaa A., Elshenawy M., Afifi N. et al. Influence of dipyridamole and its combination with NO donor or NO synthase inhibitor on adjuvant arthritis. Int Immunopharmacol. 2010;10(11):1406–14.
44. Sloka S., Metz L.M., Hader W. et al. Reduction of microglial ac- tivity in a model of multiple sclerosis by dipyridamole. J Neuroin- flammation. 2013;10:89.
45. Soliman M.M., Arafah M.M. Treatment with dipyridamole im- proves cardiac function and prevent injury in a rat model of hem- orrhage. Eur J Pharmacol. 2012;678(1–3):26–31.
46. Rheumatology: clinical guidelines. [Revmatologiya: Klinicheskie rekomendacii. Pod red. akad. RAMN E.L. Nasonova. 2-e izd., ispr. i dop]. Moskva: GEOTAR-Media, 2011. 752 s (in Russ.).
47. Arshinov A.V., Levshin N. Yu., Maslova I.G. Cardiovascular events in systemic lupus erythematosus: mechanisms for the accelerated development of atherosclerosis, diagnosis, correction capabilities. [Serdechno-sosudistye oslozhneniya pri sistemnoj krasnoj vol- chanke: mekhanizmy uskorennogo razvitiya ateroskleroza, diag- nostika, vozmozhnosti korrekcii]. Nauchno-prakticheskaya revma- tologiya. 2017;55(3):304–10 (in Russ.).
48. Gerasimova E.V., T.V. Popkova T.V., Novikova D.S. et al. Risk fac- tors of coronary artery stenosis in patients with rheumatoid arthri- tis. [Faktory riska razvitiya stenoza koronarnyh arterij u bol’nyh revmatoidnym artritom]. Nauchno-prakticheskaya revmatologiya. 2017;55(6):628–33 (in Russ.).
49. AndrienkoA.V.,LychevV.G.,UsyninV.V.,BublikovD.S.Hemorheo- logical thrombophilias in rheumatoid arthritis: problem status, ways of pharmacological correction. [Gemoreologicheskie trombofilii pri revmatoidnom artrite: sostoyanie problemy, puti farmakologicheskoj korrekcii]. Tromboz, gemostaz i reologiya. 2013;(4):62–6 (in Russ.).
50. Levshin N. Yu., Baranov A.A., Arshinov A.V., Lapkina N.A. Correc- tion of prothrombogenic status and inflammatory activity as cardio- vascular risk factors with low-molecular weight heparin of second generation. [Korrekciya sostoyaniya tromboticheskoj gotovnosti i vospalitel’noj aktivnosti kak faktora riska serdechno-sosudistyh oslozhnenij nizkomolekulyarnym geparinom vtorogo pokoleniya]. Lechashchij vrach. 2014;(7):8–14 (in Russ.).
51. Chakrabarti S., Blair P., Wu C., Freedman J.E. Redox state of dipyri- damole is a critical determinant for its beneficial antioxidant and an- tiinflammatory effects. J Cardiovasc Pharmacol. 2007;50(4):449–57.
52. Eisert W.G. Dipyridamole in antithrombotic treatment. Adv Car- diol. 2012;47:78–86.
53. Vorobeva O.V. Pleiotropic effects of dipyridamole: clinical perspec- tives. [Plejotropnye effekty dipiridamola: klinicheskie perspektivy]. Nevrologiya. 2016;3(25):15–8 (in Russ.).
54. Chen T.H., Chang C.F., Yu S.C. et al. Dipyridamole inhibits cobalt chloride-induced osteopontin expression in NRK52E cells. Eur J Pharmacol. 2009;613(1–3):10–8.
55. Hsieh M.S., Zhong W.B., Yu S.C. et al. Dipyridamole suppresses high glucose-induced osteopontin secretion and mRNA expres- sion in rat aortic smooth muscle cells. Circ J. 2010;74(6):1242–50.
56. Thrombohemorrhagic complications in obstetric-gynecological practice: a guide for physicians. [Trombogemorragicheskie os- lozhneniya v akushersko-ginekologicheskoj praktike: rukovod- stvo dlya vrachej. Pod red. A.D. Makacariya]. Moskva: MIA, 2011. 1056 s (in Russ.).
57. Instruction for use Curantil® N25 (PN013897/01–280312 and PN013897/01–290514). [Instrukciya po medicinskomu primeneniyu preparata Kurantil® N25 (PN013897/01–280312 i PN013897/01– 290514)] (in Russ.). Available at: https://medi.ru/instrukciya/ku- rantil-25_247.
