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Antiplatelet therapy for acute ischaemic stroke.
P Sandercock1, G Gubitz, P Foley
1Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU. pags@skull.dcn.ed.ac.uk
The Cochrane Database of Systematic Reviews
|June 14, 2003
Summary
Early antiplatelet therapy with aspirin significantly reduces death and disability following acute ischaemic stroke. This treatment improves long-term outcomes and recovery, with a low risk of serious bleeding complications.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Platelet activation is a key factor 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 efficacy and safety of antiplatelet therapy in patients with acute ischemic stroke.
Main Methods:
- Systematic review of randomized controlled trials comparing antiplatelet therapy with control.
- Searches included major medical databases and trial registers up to August 2002.
- Data extraction and quality assessment were performed independently by two reviewers.
Main Results:
- Nine trials with 41,399 patients were included; 98% of data came from two aspirin trials.
- Treatment significantly decreased death or dependency (OR=0.94) and improved complete recovery (OR=1.06).
- A small excess of intracranial hemorrhages was offset by reductions in recurrent strokes and pulmonary emboli.
Conclusions:
- Aspirin (160-300 mg daily) initiated within 48 hours of ischemic stroke onset improves long-term outcomes.
- The therapy reduces recurrent ischemic stroke risk without a significant increase in early hemorrhagic complications.
- Oral or rectal administration is effective for patients unable to swallow.