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United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: interim results. UK-TIA Study Group
Insights
Low-dose aspirin (300 mg daily) significantly reduced gastrotoxicity while offering similar benefits to higher doses for patients experiencing transient ischemic attack or minor ischemic stroke.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Transient ischemic attack (TIA) and minor ischemic stroke represent significant cardiovascular risks.
- Effective long-term management strategies are crucial for preventing recurrent events.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of different aspirin dosages in patients with a history of TIA or minor ischemic stroke.
- To compare the effects of aspirin 600 mg twice daily, 300 mg once daily, and placebo on major vascular events.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 2435 patients.
- Patients received either aspirin (600 mg BID or 300 mg QD) or placebo for a mean duration of four years.
- Outcomes included non-fatal myocardial infarction, non-fatal major stroke, vascular death, and non-vascular death.
Main Results:
- Aspirin treatment (both dosages combined) reduced the odds of experiencing major adverse events by 18% compared to placebo (2p = 0.01).
- A 7% reduction in disabling stroke or vascular death was observed with aspirin, though not statistically significant.
- The 300 mg daily dose demonstrated significantly less gastrotoxicity than the 600 mg twice-daily dose.
Conclusions:
- Long-term aspirin therapy is effective in reducing the risk of major vascular events in patients with TIA or minor ischemic stroke.
- Aspirin 300 mg once daily appears to be a favorable option due to comparable efficacy and improved gastrointestinal tolerability.
- Further research may be warranted to fully elucidate the optimal aspirin dosage for secondary stroke prevention.
Abstract:
From 1979 to 1985, 2435 patients thought to have had a transient ischaemic attack or minor ischaemic stroke were allocated at random to receive long term blind treatment with either aspirin 600 mg twice daily (n = 815), aspirin 300 mg once daily (806), or placebo (814). Treatment continued with about 85% compliance until September 1986 (mean four years). The odds of suffering one or more of four categories of event--namely, non-fatal myocardial infarction, non-fatal major stroke, vascular death, or non-vascular death--were 18% less in the two groups allocated to receive aspirin than in the group allocated to receive placebo (2p = 0.01). The more relevant but less frequent composite event of disabling stroke or vascular death was reduced by only 7%; this reduction was not significantly different from zero, but nor was it significantly different from a 25% reduction. There was no definite difference between responses to the 300 mg and 1200 mg daily doses, except that the lower dose was significantly less gastrotoxic.