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Aspirin and Stroke
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Recent studies make it clear that for many people, especially women, this little pill can be a lifesaver
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By John McIntosh
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REMEDY Summer 2005
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Studies presented at the 30th International Stroke Conference in February, 2005 revealed that aspirin reduces the probability of stroke for those at risk, and when taken daily in small doses it may help prevent or alleviate the complications of a second stroke.
Furthermore, if you’ve suffered a stroke and you’re taking aspirin, ceasing to take this wonder drug elevates your chances of having another stroke. So talk with your doctor about taking a daily dose of aspirin, and stick with it if it is prescribed.
While millions of Americans take 81 mg of aspirin a day to try to prevent a stroke or heart attack, it does not always work, particularly for the 5 to 40 percent for whom aspirin does not help prevent blood clots. However, aspirin still offers important benefits. Those taking aspirin who go on to have a stroke appear to have less severe strokes than if they had not been taking the drug.
Nerses Sanossian, M.D., a neurologist with the UCLA Stroke Center and author of “Prophylactic Aspirin May Reduce Severity of Strokes Compared With Other Anti-Thrombotics,” suggests that aspirin may be more protective than the other anticlotting medications because it limits both the size of the clots and their number. “It is very interesting,” he says, “that the effect seems limited to aspirin alone and not to all antithrombotic agents. Our study found that 13 percent of patients using aspirin for prevention had severe strokes, while 24 percent of those using other types of anticlotting drugs had severe strokes.” Twenty-three percent of those taking no preventive drugs at all had severe strokes.
According to the American Stroke Association, every 45 seconds someone in America has a stroke. That would be about 700,000 people this year. And stroke is our nation’s number-three killer and a leading cause of severe, long-term disability. To help reduce the devastating aftereffects, 160 to 325 mg of aspirin within 48 hours of an ischemic stroke may offer a small but statistically significant decrease in death rates and disability from stroke. That was the consensus finding issued by the American Stroke Association and the American Academy of Neurology in 2002.
Healthy women ages 45 and older can reduce their risk of a stroke by taking 100 mg of aspirin every other day, according to a recent study published in The New England Journal of Medicine. Researchers from a consortium of medical organizations, including Brigham and Women’s Hospital and the Harvard School of Public Health, looked at almost 40,000 women for 10 years to track their response to the therapy. What they found is that aspirin significantly reduced the risk of major cardiovascular events, ischemic stroke and heart attack among women 65 years of age and older. And aspirin reduced the incidence of a first stroke by 17 percent in all women studied.
The stroke prevention findings are especially significant for women because, according to the American Heart Association, each year 40,000 more women than men have strokes, and more than 60 percent of total stroke deaths happen to women. In addition, 14 percent of those who survive a first stroke or heart attack will have another within a year.
Researchers at the International Stroke Conference presented a study that revealed how important it is to continue with prescribed therapy. According to the study “Discontinuation of Aspirin Prophylaxis Linked to Increased Risk of Stroke Recurrence,” if stroke survivors discontinue aspirin therapy, they may triple their risk of having a repeat stroke within one month. “This is the first controlled retrospective study to investigate the potential risk of ischemic stroke shortly after discontinuing aspirin,” says coauthor Patrik Michel, M.D., director of the acute stroke unit at Lausanne University Hospital in Switzerland. Dr. Michel and coinvestigators chose the one-month time period for their study because prior research shows that ischemic events caused by rebound effects typically occur within four weeks of aspirin interruption.
Exactly why aspirin is such a powerful and beneficial drug is only partially understood, but it appears that acetylsalicylic acid (aspirin’s active chemical compound) conveys its benefits by influencing the body’s production of some forms of hormone—like substances called prostaglandins. These important hormones play a role in triggering a fever and inflammation. They also induce birth contractions and menstrual cramps and are suspected of playing a role
in the development of malignant tumors (cancer) and the formation of clots that obstruct blood vessels.
Recent studies also show that influencing these hormones may play a role in preventing colon and breast cancer and in reducing the risk of heart attack and stroke. Sweden’s Hypertension Optimal Treatment study found that taking low-dose aspirin in addition to accepted treatment regimens for hypertension can cut the risk of heart attack and stroke by 23 percent.
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