In-Hospital Aspirin Dose as a Risk Factor for Hemorrhagic Transformation in Patients Not Treated With Thrombolysis

Area of Science:

• Neurology
• Pharmacology
• Cardiovascular Medicine

Background:

• Aspirin is a standard secondary prophylaxis for acute ischemic stroke.
• The association between aspirin dosage and hemorrhagic transformation (HT) risk remains unclear.
• Predictive scores for HT exist, but their clinical application requires further investigation.

Purpose of the Study:

• To investigate the relationship between in-hospital daily aspirin dose (IAD) and HT in acute ischemic stroke patients.
• To determine if higher aspirin doses are associated with increased HT risk, particularly in high-risk individuals.

Main Methods:

• Retrospective cohort study of 986 acute ischemic stroke patients (2015-2017).
• In-hospital daily aspirin dose (IAD) was determined by the attending team.
• Hemorrhagic transformation (HT) risk assessed using a predictive score for patients not receiving reperfusion therapy.
• Regression models analyzed correlations between HT and IAD.

Main Results:

• Overall HT prevalence was 19.2%; parenchymatous hematomas type-2 (PH-2) occurred in 10% of cases.
• IAD was not significantly associated with HT or PH-2 in the general patient cohort.
• In high-risk patients (predictive score ≥3, no reperfusion), higher IAD correlated with PH-2 (OR 1.01, P=0.03).
• A 200 mg aspirin dose was protective against PH-2 compared to 300 mg (OR 0.102, P=0.009).

Conclusions:

• Increased in-hospital aspirin dose is linked to intracerebral hematoma in high-risk acute ischemic stroke patients.
• Risk stratification for HT could guide individualized aspirin dosing strategies.
• Further clinical trials are necessary to confirm these findings and inform treatment guidelines.