Prompt use of aspirin should be routinely considered for all patients with suspected acute ischaemic stroke, mainly to reduce the risk of early recurrence, according to the results of a meta-analysis.
Dr ZhengMing Chen (clinical trial service unit and epidemiological studies unit, Radcliffe Infirmary, Oxford) and colleagues say that it is already known that long-term daily aspirin is beneficial following an ischaemic stroke. However, some uncertainty remains about its use in particular patients. They conducted a meta-analysis to assess the balance of benefits and risks of aspirin in different groups of patient. Data on 40,000 patients from two large studies, the Chinese acute stroke trial and the international stroke trial were included in the meta-analysis.
Dr Chen and colleagues found that aspirin reduced the risk of recurrent ischaemic stroke from 2.3 to 1.6 per cent and reduced the risk of death from 5.4 to 5.0 per cent. This risk reduction was similar in all sub-groups and did not differ substantially with respect to age, sex, level of consciousness, atrial fibrillation, CT findings, blood pressure, stroke subtype or concomitant heparin use. While beneficial overall, aspirin increased the risk of haemorrhage from 0.8 to 1.0 per cent (Stroke 2000;31:1240).