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Aspirin Use & Early Recurrent Stroke Risk

Lancet; ePub 2016 May 18; Rothwell, Algra, et al

Publish date:

Aspirin use is a key intervention in overall medical treatment that substantially reduces the risk of early recurrent stroke after transient ischemic attack (TIA) and minor stroke, and self-administration of aspirin after possible TIA has considerable early benefit. This according to pooled data for 15,778 participants from 12 trials of aspirin vs control in secondary prevention. Researchers found:

• Aspirin reduced the 6-week risk of recurrent ischemic stroke by ~60% and disabling or fatal ischemic stroke by ~70%, with greatest benefit in patients presenting with TIA or minor stroke.

• The effect of aspirin on early recurrent ischemic stroke was due partly to a substantial reduction in severity; these effects were independent of dose, patient characteristics, or etiology of TIA or stroke.

• In patients presenting with TIA or minor stroke aspirin reduced the risk of disabling or fatal stroke by approximately 90%.

• Further reduction in risk of ischemic stroke accrued for aspirin only vs control from 6 to 12 weeks, but there was no benefit after 12 weeks.

Citation: Rothwell PM, Algra A, Chen Z, Diener HC, Norrving B, Mehta Z. Effects of aspirin on risk of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trails. [Published online ahead of print May 18, 2016]. Lancet. doi:http://dx.doi.org/10.1016/S0140-6736(16)30468-8.

Commentary: Recurrent stroke can occur in up to 10% of people in the week following a TIA or minor stroke.1 This study, showing up to a 90% decrease in the risk of disabling or fatal stroke after use of aspirin in patients with a TIA, underscores the importance of acute evaluation in the setting of suspected TIA. As the authors point out in their discussion, consideration may be given to advising patients to take aspirin in the setting of suspected TIA, similar to the way patients now are advised to take aspirin in the setting of suspect cardiac chest pain. At this point, this is not the recommendation of any official stroke guideline, and treatment before an evaluation with a CT has some risk since approximately 5% of strokes may be hemorrhagic which would not benefit, and which could be made worse, with administration of aspirin. After evaluation though, once a hemorrhagic stroke is excluded, patients should be given aspirin to decrease the likelihood of recurrent severe stroke. —Neil Skolnik, MD

1. Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000;284:2901–06.

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