BY Will Boggs, MD
WESTPORT, CT (Reuters Health) – Patients with stroke who have previously used aspirin have milder clinical deficits at stroke onset. The finding comes from data collected for an acute stroke treatment trial, and is published in the December issue of Stroke: Journal of the American Heart Association.
While aspirin clearly reduces stroke incidence, evidence is inconsistent regarding the benefits of aspirin use in stroke survivors, the authors explain.
Dr. Janet Wilterdink from Brown Medical School in Providence, Rhode Island and colleagues used data from the Trial of Org 10172 in Acute Stroke Treatment (TOAST) to compare stroke severity among 509 users and 766 nonusers of aspirin.
Mean National Institutes of Health Stroke Scale (NIHSS) scores and mean Supplemental Motor Examination (SME) scores were significantly lower (p = 0.003 and p = 0.004, respectively) at presentation among aspirin users than among aspirin nonusers, the investigators report.
By 3 months after the stroke, aspirin users continued to show milder motor deficits (as measured by the SME), the report indicates, but differences in NIHSS scores were no longer statistically significant.
Mortality at 7 days and at 3 months did not differ statistically between the groups, the researchers note, and infarct size was similar for users and nonusers.
"Physicians often speak of patients as 'aspirin failures' when they have a TIA while taking aspirin," Dr. Wilterdink told Reuters Health. "In fact, that TIA or minor stroke may have been a major stroke if the patient had not been on aspirin."
"The same philosophy applies to other stroke prevention measures–blood pressure lowering, smoking cessation, cholesterol lowering, etc. Patients should not get the message that these interventions did not work because they had a cerebrovascular event 'despite' these interventions," Dr. Wilterdink said.
She and her colleagues recommend that "future clinical trials testing treatments for acute ischemic stroke should ensure that use of aspirin before stroke is comparable in all study groups."
Stroke 2001;32:000-000.
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