Medicine by the Numbers

A Collaboration of TheNNT.com and AFP

Aspirin After Acute Ischemic Stroke

 

Am Fam Physician. 2020 Sep 1;102(5):online.

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Details for This Review

Study Population: Adults presenting with acute stroke

Efficacy End Points: Death or dependence, recurrent stroke, complete recovery from stroke

Harm End Points: Symptomatic intracranial hemorrhage, major extracranial hemorrhage

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ASPIRIN AFTER ACUTE ISCHEMIC STROKE

BenefitsHarms

1 in 79 did not die or become dependent 1 in 140 did not have a recurrent stroke 1 in 89 completely recovered from their stroke

1 in 574 developed a symptomatic intracranial hemorrhage 1 in 245 developed a major extracranial hemorrhage

ASPIRIN AFTER ACUTE ISCHEMIC STROKE

BenefitsHarms

1 in 79 did not die or become dependent 1 in 140 did not have a recurrent stroke 1 in 89 completely recovered from their stroke

1 in 574 developed a symptomatic intracranial hemorrhage 1 in 245 developed a major extracranial hemorrhage

Narrative: Each year in the United States, approximately 610,000 people have a stroke for the first time, and an additional 185,000 have recurrent strokes. Of these, 87% are ischemic strokes,1 and are most often caused by thrombosis or embolism and a subsequent lack of blood flow. In ischemic strokes, platelets become activated and release neurotoxic and thrombogenic molecules,2 which makes antiplatelet therapy a logical choice. A potential harm of this therapy is bleeding, especially intracranially. The goal of this summary is to provide updated evidence on the safety and effectiveness of immediate oral antiplatelet therapy in patients presenting with acute ischemic stroke.

This Cochrane systematic review identified eight randomized controlled trials involving 41,483 predominantly older patients with presumed acute ischemic stroke.3 Two studies (International Stroke Trial [IST]4 and the Chinese Acute Stroke Trial [CAST]5), accounted for 98% of the data. The IST randomized patients to receive 300 mg per day of aspirin for two weeks or no treatment, and the CAST randomized patients to receive 160 mg per day of aspirin for four weeks or placebo within 48 hours of presentation. The primary outcome was death or dependency at least one month after stroke (six months for patients in the IST and one month for patients in the CAST). Secondary outcomes measured during the treatment period (two weeks

Author disclosure: No relevant financial affiliations.


Copyright ©2020 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and Daniel Runde, MD, from the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.

References

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1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics—2017 update: a report from the American Heart Association [published corrections appear in Circulation. 2017;135(10):e646, and Circulation. 2017;136(10):e196]. Circulation. 2017;135(10):e146–e603....

2. Van Kooten F, Ciabattoni G, Patrono C, et al. Evidence for episodic platelet activation in acute ischemic stroke. Stroke. 1994;25(2):278–281.

3. Sandercock PAG, Counsell C, Tseng M, et al. Oral antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev. 2014;(3):CD000029.

4. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19,435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349(9065):1569–1581.

5. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997;349(9066):1641–1649.

6. Chen ZM, Sandercock P, Pan HC, et al. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40 000 randomized patients from the Chinese Acute Stroke Trial and the International Stroke Trial. On behalf of the CAST and IST Collaborative Groups. Stroke. 2000;31(6):1240–1249.

 

 

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