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Antiplatelet therapy for acute ischaemic stroke
G Gubitz1, P Sandercock, C Counsell
1Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU. pags@skull.dcn.ed.ac.uk
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Early antiplatelet therapy for acute ischemic stroke significantly reduces death and disability, improving long-term outcomes. This treatment also lowers the risk of recurrent strokes without a major increase in bleeding complications.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Platelet activation is a key feature in acute ischemic stroke.
- Antiplatelet therapy may mitigate ischemic brain damage and reduce early stroke recurrence.
- Potential benefits must be weighed against the risk of intracranial hemorrhage.
Purpose of the Study:
- To evaluate the overall impact of antiplatelet therapy in patients with acute ischemic stroke.
- To determine the net clinical benefit of early antiplatelet intervention.
Main Methods:
- Systematic review of randomized controlled trials comparing antiplatelet therapy with control.
- Searches included major trial registries and databases up to March 1999.
- Data extraction and quality assessment performed by two independent reviewers.
Main Results:
- Eight trials with 41,325 patients were analyzed; 98% of data from aspirin trials (160-300 mg daily) initiated within 48 hours.
- Significant reduction in death or dependency (OR=0.94) and improved odds of complete recovery (OR=1.06).
- A small increase in intracranial hemorrhage (2/1000) was offset by a greater reduction in recurrent ischemic strokes (7/1000).
Conclusions:
- Early administration of aspirin (160-300 mg daily) for acute ischemic stroke is beneficial.
- Treatment reduces the risk of recurrent ischemic stroke and improves long-term outcomes.
- The benefits outweigh the risks of early hemorrhagic complications.