Aspirin in Stroke Prevention

  • James C. Grotta


Aspirin is now standard preventive therapy in patients at risk for stroke, but many questions remain about its efficacy and use. No single trial has clearly demonstrated the efficacy of aspirin for prevention of stroke after transient ischemic attack (TIA). However, almost all studies showed some benefit in the aspirin group. Recently, metaanalysis, integrating and analyzing data from multiple studies, has attempted to clarify the picture. One such analysis1 showed no significant benefit for aspirin alone. Another analysis was carried out in collaboration with the principal investigators of all studies of platelet antiaggregate drugs for prevention of vascular disease, and weighted the studies according to the numbers of patients in each. This represented 25 completed studies enrolling 29 000 patients with angina, myocardial infarction, TIA, or stroke.


Transient Ischemic Attack Stroke Prevention Aspirin Group Intraplaque Hemorrhage Carotid Artery Plaque 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sze PC, Reitman D, Pincus MM, et al. Antiplatelet agents in the secondary prevention of stroke: metaanalysis of the randomized control trials. Stroke. 1988;19:436–442.PubMedCrossRefGoogle Scholar
  2. 2.
    Antiplatelet Trialists’ Collaboration: Secondary prevention of vascular disease by prolonged antiplatelet treatment. Br Med J. 1988;296:320–331.CrossRefGoogle Scholar
  3. 3.
    Weksler BB, Pett SB, Alonso D, et al. Differential inhibition by aspirin of vascular and platelet prostaglandin synthesis in atherosclerotic patients. N Engl J Med. 1983;308:800–805.PubMedCrossRefGoogle Scholar
  4. 4.
    Weksler BB, Kent JL, Rudolph D, et al. Effects of low dose aspirin on platelet function in patients with recent cerebral ischemia. Stroke. 1985; 16:5.PubMedCrossRefGoogle Scholar
  5. 5.
    Tohgi H, Tamura K, Kimura M, et al. Individual variation in platelet aggregability and serum thrombox-ane B2 concentrations after low-dose aspirin. Stroke. 1988;19:700–703.PubMedCrossRefGoogle Scholar
  6. 6.
    UK-TIA Study Group: United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: interim results. Br Med J. 1988;296:316–319.CrossRefGoogle Scholar
  7. 7.
    Steering Committee of the Physicians’ Health Study Research Group: Final report on the aspirin component of the ongoing physicians’ health study. N Engl J Med. 1989;321:129–135.CrossRefGoogle Scholar
  8. 8.
    Boysen G, Sorensen S, Juhler M, et al. Danish very-low-dose aspirin after carotid endarterectomy trial. Stroke. 1988;19:1211–1215.PubMedCrossRefGoogle Scholar
  9. 9.
    Petersen P, Boysen G, Godtfredsen J, et al. Placebo- controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. Lancet. 1989;1:175–179.PubMedCrossRefGoogle Scholar
  10. 10.
    Grotta JC, Lemak NA, Gary H, et al. Does platelet antiaggregant therapy lessen the severity of stroke? Neurol. 1985;35:632–636.CrossRefGoogle Scholar
  11. 11.
    Fields WS, Lemak NA, Frankowski RF, et al. Controlled trial of aspirin in cerebral ischemia. Stroke. 1977;8:301–316.PubMedCrossRefGoogle Scholar
  12. 12.
    European Stroke Prevention Study Group. The European stroke prevention study (ESPS). Lancet. 1987; 2:1351–1353.Google Scholar
  13. 13.
    Biller J, Bruno A, Adams HP, et al. A randomized trial of aspirin or heparin in hospitalized patients \ with recent transient ischemic attacks. Stroke. 1989;20:441–447.PubMedCrossRefGoogle Scholar
  14. 14.
    Awad IA, Johnson PC, Spetzler RF, et al. Incidental subcortical lesions identified on magnetic resonance imaging in the elderly: II. Postmortem pathological correlations. Stroke. 1986; 17:1090–1097.PubMedCrossRefGoogle Scholar
  15. 15.
    Steingart A, Hachinski VC, Lau C, et al. Cognitive and neurologic findings in subjects with diffuse white matter lucencies on computed tomographic scan (leuko-araiosis). Arch Neurol. 1987; 44:32–35.PubMedCrossRefGoogle Scholar
  16. 17.
    Peto R, Gray R, Collins R, et al. Randomised trial of prophylactic daily aspirin in British male doctors. Br Med J. 1988;296:313–315.CrossRefGoogle Scholar
  17. 18.
    Fuster V, Cohen M, and Halperin J. Aspirin in the prevention of coronary disease. N Engl J Med. 1989; 321:183–185.PubMedCrossRefGoogle Scholar
  18. 19.
    Aspirin for prevention of myocardial infarctions and stroke. In: Abramswicz M, eds. The Medical Letter. 1989;31:77–79.Google Scholar
  19. 20.
    Grotta JC, Yatsu FM, Pettigrew LC, et al. Prediction of carotid stenosis progression by lipid and hematologic measurements. Neurol. 1989;39:1325–1331.CrossRefGoogle Scholar
  20. 21.
    Ross R. The pathogenesis of atherosclerosis. An update. N Engl J Med. 1986;314:488–500.PubMedCrossRefGoogle Scholar
  21. 22.
    Metke MP, Lie JT, Fuster V, et al. Reduction of intimal thickening in canine coronary bypass vein grafts with dipyridamole and aspirin. Amer J Cardiol. 1979;43:1144–1148.PubMedCrossRefGoogle Scholar
  22. 23.
    Chesebro JH, Fuster V, Elveback LR, et al. Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations. N Engl J Med. 1984;310:209–214.PubMedCrossRefGoogle Scholar
  23. 24.
    Hess H, Mietaschk A, Deichsel G. Drug-induced inhibition of platelet function delays progression of peripheral occlusive arterial disease. A prospective double-blind arteriographically controlled trial. Lancet. 1985;1:414–419.Google Scholar
  24. 25.
    Hansen KJ, Howe HR, Edgerton A, et al. Ticlopidine versus aspirin and dipyridamole: Influence on platelet deposition and three-month patency of polytetrafluoroethylene grafts. J Vasc Surg. 1986;4:174–178.PubMedGoogle Scholar
  25. 26.
    Verstraete M, Brown BG, Chesebro JH, et al. Evaluation of antiplatelet agents in the prevention of aorto-coronary bypass occlusion. Eur Heart. 1986; 7:4–13.Google Scholar
  26. 27.
    Imparato AM, Riles TS, Mintzer R, et al. The importance of hemorrhage in the relationship between gross morphologic characteristics and cerebral symptoms in 376 carotid artery plaques. Ann Surg. 1983;197:195–203.PubMedCrossRefGoogle Scholar
  27. 28.
    Fisher M, Blumenfeld AM, Smith TW The importance of carotid artery plaque disruption and hemorrhage. Arch Neurol. 1987;44:1086–1089.PubMedCrossRefGoogle Scholar
  28. 29.
    Lannihan L, Kupsky WJ, Mohr JP, et al. Lack of association between carotid plaque hematoma and ischemic cerebral symptoms. Stroke. 1987; 18:879–881.CrossRefGoogle Scholar
  29. 30.
    Chambers BR, Norris JW. Outcome inpatients with asymptomatic neck bruits. N Engl J Med. 1986;315: 860–865.PubMedCrossRefGoogle Scholar
  30. 31.
    Hennerici M, Hulsbomer HB, Hefter H, et al. National history of asymptomatic extracranial arterial disease. Brain. 1987;110:777–791.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1991

Authors and Affiliations

  • James C. Grotta

There are no affiliations available

Personalised recommendations