Aspirin Can Save Lives After Stroke

Experts recommend giving two tablets within 48 hours

MONDAY, July 8, 2002 (HealthDayNews) -- Once again, plain old aspirin comes up a winner as a treatment for a serious cardiovascular problem.

This time, the problem is ischemic stroke, the kind that happens when a clot blocks a brain artery; a stroke can also happen when an artery tears open. After an exhaustive search of the medical literature, a joint committee of the American Academy of Neurology and the American Stroke Association concludes one or two aspirin tablets given in the first 48 hours after a stroke occurs can save lives and reduce lasting damage.

"Based on our review, we do agree that aspirin given in acute stroke has a benefit for stroke patients," says Dr. Bruce Coull, head of the neurology department at the Arizona Health Science Center, who chaired the joint committee. "The benefit is slight, but nonetheless there. To rescue one person, we need to treat 100 individuals."

Aspirin is known to reduce clot formation by preventing blood platelets from clumping together. The committee could not find enough evidence to make a recommendation about anti-platelet drugs.

It's important to note the information is aimed at doctors, not the general public, says Dr. Larry Goldstein, director of the Stroke Center at Duke University Medical Center, who helped prepare a report appearing both in tomorrow's issue of Neurology and the July issue of Stroke.

"There is no data showing that taking aspirin at home if someone is having a stroke will do any good," Goldstein says. "It might do harm if the person is having a bleeding stroke rather than a thrombolytic stroke."

The beneficial effects of aspirin are obviously not overwhelming, Goldstein says. "The benefit is small, but the cost of the drug is also small, so it can benefit a lot of patients."

It took a lot of reading and winnowing of the scientific literature to come up with the joint statement, Goldstein says. "It was developed over a period of about two years, and involved a very systematic approach to the literature addressing this question."

The question of what, if any, drug could help in the hours after a stroke "has been a matter of ongoing concern," he says. "There has been considerable uncertainty about what anticoagulants or anti-thrombotics should be used."

The people making the report started with 2,000 articles that were potentially useful, Goldstein says. Just 310 of those met the criteria for usefulness "and only 10 made the final cut," he says. "So you can see why there has been such concern about the scientific evidence."

"These results emphasize the importance of reviewing all the evidence to develop practice guidelines," Coull says. "Despite decades of use and physiologic reasons for its use, there were surprisingly few randomized trials that addressed the effects of using heparin and other anticoagulants within a few hours of the onset of symptoms."

Heparin was another winner in the survey. While aspirin prevents the formation of artery-blocking clots by preventing the clumping together of blood platelets, heparin slows the process of clotting by a different mechanism. However, the recommendation about heparin was much more limited.

An injection of heparin seems to prevent the recurrence of stroke, but that benefit must be balanced against the risk of a hemorrhage, so the committee is not recommending it for that purpose. However, heparin does seem to prevent deep vein thrombosis, the formation of clots that block veins, especially in the legs, that can be fatal, the committee says, so its use should be considered for some patients.

The heparin recommendation might settle a debate that has been going on for years, Coull says. "Heparin has been extremely controversial, and doctors have had arguments about it constantly," he says. "In our review, it was surprising how little data was available to support these arguments."

The importance of the study is that it was done at all, Goldstein says.

"It does provide evidence-based statements about what we currently know about the use of these drugs," he says. It's hoped that some ongoing studies will give more evidence about the best drugs to use for emergency treatment of strokes, he says.

What To Do

To learn more about stroke, turn to the American Stroke Association or the National Institute of Neurological Disorders and Stroke.

The American Heart Association recommends aspirin to prevent strokes and heart attacks.

SOURCES: Larry Goldstein, M.D., director, stroke center, Duke University Medical Center, Durham, N.C.; Bruce Coull, M.D., chairman, Department of Neurology, University of Arizona Health Science Center, Tucson; July 9, 2002, Stroke; July 9, 2002, Neurology
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