Aspirin is already recommended to prevent further cardiovascular disease (CVD) events after a transient ischaemic attack (TIA) or ischaemic stroke based on clinical trials that show a 13% long-term reduction in recurrent stroke. New pooled data from 15,778 participants in 12 clinical trials of aspirin versus control showed the use of aspirin reduced the 6 week risk of recurrent ischaemic stroke by 60% and disabling or fatal ischaemic stroke by approximately 70%. The greatest benefit from aspirin was seen in those presenting with TIA or minor stroke (Rothwell et al 2016).
Peter Rothwell, Professor of Neurology at Oxford University and Chair of the International Aspirin Foundation Scientific Advisory Board, whose team’s findings were published in The Lancet on May 18th commented on BBC Radio 4’s Today programme;
“It’s a much bigger effect than we expected and of course the relevance of it is there is aspirin in nearly every household in the country so it’s something that can be done very quickly after people develop symptoms.”
The advice to take aspirin immediately after symptoms of minor stroke are not however always given and it is important that both health professions and the general public understand the impact this early intervention with aspirin can have on a person’s subsequent health and survival.
“At the moment patients … often don’t get told to take aspirin so we’d be trying to get the guidelines updated to say that as soon as a patient seeks medical attention if there is a suspicion of a mini stroke they should be advised to take aspirin immediately.”
“There is a high risk of a major stroke in those first few hours and days after these minor warning symptoms so patients are really on a knife edge here; they can tip forward into a very big disabling or fatal stroke or they can be tipped back fairly easily by something like aspirin just to make the blood less sticky and reduce the risk of a big stroke.”
The risks from administering aspirin to patients with suspected TIA or ischaemic stroke, before brain imaging to check for intracerebral haemorrhage (ICH), are low as this is rare with transient or mild focal neurological symptoms. Where there is trial data of aspirin use in these patients no adverse outcomes resulting from the aspirin administration have been reported. There is however evidence to suggest that the use of antiplatelet therapy at the time of intracerebral haemorrhage may increase mortality (Hankey 2016). Therefore targeting this immediate aspirin intervention at those with minor symptoms of ischaemic stroke and TIA is important.
Education and new guidelines to promote the immediate self-administration of aspirin as a key intervention in preventing early recurrent stroke after TIA or minor stroke is vital to exploit these new findings.
Source: The International Aspirin Foundation
Full bibliographic information:
1. Hankey GJ. The benefits of aspirin in early secondary stroke prevention. www.lancet.com. Published online May 18, 2016 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2930511-6
2. Rothwell PM, Algra A, Chen Z, Diener HC, Norrving B and Mehta Z. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. www.lancet.com Published online May 18, 2016 @ http://dx.doi.org/10.1016/S0140-6736(16)30468-8