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Aspirin or heparin in acute stroke
1Department of Clinical Neurology, Institute of Neurology, University College London, UK.
British Medical Bulletin
|November 25, 2000
Summary
Aspirin (acetylsalicylic acid) improves outcomes for acute stroke patients by reducing death and dependency. It also prevents recurrent ischemic strokes, making it a valuable early secondary prevention tool.
Area of Science:
- Neurology
- Clinical Trials
- Pharmacology
Background:
- Acute stroke management involves evaluating treatments like aspirin and heparin.
- Large-scale randomized trials, including the International Stroke Trial (IST) and Chinese Acute Stroke Trial (CAST), have investigated these interventions.
Purpose of the Study:
- To assess the efficacy of aspirin and heparin in acute stroke patients.
- To determine the impact of these treatments on patient outcomes, including death, dependency, and recurrent stroke.
Main Methods:
- Combined analysis of data from over 40,000 patients randomized in the IST and CAST trials.
- Evaluation of aspirin (150-300 mg) administered within 48 hours of stroke onset.
- Assessment of heparin's effects, including its impact on recurrent ischemic stroke and cerebral hemorrhage.
Main Results:
- Aspirin significantly improved outcomes (reduced death or dependency) by approximately 1% at 4 weeks to 6 months post-stroke.
- Aspirin significantly reduced recurrent ischemic stroke without increasing cerebral hemorrhage.
- Heparin did not improve overall clinical outcomes and increased cerebral hemorrhage risk, despite reducing recurrent ischemic strokes in one trial.
Conclusions:
- Aspirin is recommended for early secondary prevention of recurrent stroke in acute stroke patients, following exclusion of cerebral hemorrhage via imaging.
- Heparin is not recommended as routine therapy for acute stroke but may be considered for patients at high risk of deep vein thrombosis or early recurrence.