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[Aspirin and cerebral ischemic accidents]
I Crassard1, P Niclot, M G Bousser
1Service de neurologie, hôpital Lariboisière, Paris, France.
Insights
Aspirin effectively reduces mortality and stroke recurrence in acute cerebral infarction. It also prevents myocardial infarction but is less effective for stroke prevention in primary care.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Aspirin is a widely used antiplatelet medication.
- Its efficacy in preventing thrombotic events is well-established.
- Different clinical scenarios require varied therapeutic approaches.
Purpose of the Study:
- To review the role of aspirin in preventing cardiovascular and cerebrovascular events.
- To compare aspirin with other antiplatelet agents and anticoagulants.
- To highlight optimal aspirin dosage and indications.
Main Methods:
- Review of large-scale studies on aspirin's efficacy.
- Analysis of data on primary and secondary prevention of atherothrombotic events.
- Comparison of different antiplatelet drugs and anticoagulation strategies.
Main Results:
- Aspirin reduces mortality and stroke recurrence in acute cerebral infarction.
- It significantly lowers myocardial infarction risk in primary prevention but not stroke risk.
- Aspirin is cost-effective for secondary prevention of atherothrombotic brain infarcts, with optimal doses between 100-300 mg.
- Oral anticoagulants are preferred for high-risk cardiac conditions like nonvalvular atrial fibrillation.
Conclusions:
- Aspirin remains a cornerstone in managing acute cerebral infarction and secondary prevention.
- Risk stratification guides the choice between aspirin and oral anticoagulants in nonvalvular atrial fibrillation.
- Further research on combination therapies and vascular risk factor management is needed.
Abstract:
At the acute phase of cerebral infarction, two recent large studies found that the use of aspirin reduces both mortality and the risk of the recurrence of stroke. In primary prevention, aspirin nearly halves the risk of myocardial infarction but does not reduce that of stroke. Concerning the secondary prevention of atherothrombotic brain infarcts, aspirin has been the most extensively studied drug, and is efficient between 50 mg and 1.3 g. In spite of the efficacy of other antiplatelets in this indication--ticlopidine (500 mg), clopidogrel (75 mg) and dipyridamole (400 mg)--aspirin remains the most cost-effective, doses between 100 and 300 mg being the most widely used. Cardiac diseases with a high embolic risk require the use of oral anticoagulation. In nonvalvular atrial fibrillation, the choice of antithrombotic drugs depends on risk stratification: oral anticoagulants are indicated in high-risk subjects, whereas aspirin is recommended in low-risk subjects and when oral anticoagulants are contraindicated. Studies with associations of aspirin and other antiplatelets are required to increase the yield of this medication in high-risk subjects, in parallel with efforts to detect and to treat the vascular risk factors.