Immediate aspirin after mini-stroke substantially reduces risk of major stroke

May 18, 2016, University of Oxford
Micrograph showing cortical pseudolaminar necrosis, a finding seen in strokes on medical imaging and at autopsy. H&E-LFB stain. Credit: Nephron/Wikipedia

Using aspirin urgently could substantially reduce the risk of major strokes in patients who have minor 'warning' events, a group of European researchers has found. Writing in the Lancet, the team say that immediate self-treatment when patients experience stroke-like symptoms would considerably reduce the risk of major stroke over the next few days.

Aspirin is already given to people who have had a or transient ischaemic attack (TIA - often called a 'mini-stroke') to prevent further strokes after they have been assessed in hospital and in the longer-term, reducing the subsequent stroke risk by about 15%. However, based on a previous study in Oxford (the EXPRESS Study) the team suspected that the benefits of more immediate treatment with aspirin could be much greater.

Lead researcher Professor Peter Rothwell, a stroke expert from the University of Oxford, explained: 'The risk of a major stroke is very high immediately after a TIA or a (about 1000 times higher than the background rate), but only for a few days. We showed previously in the 'EXPRESS Study' that urgent medical treatment with a 'cocktail' of different drugs could reduce the one-week risk of stroke from about 10% to about 2%, but we didn't know which component of the 'cocktail' was most important.'

'One of the treatments that we used was aspirin, but we know from other trials that the long-term benefit of aspirin in preventing stroke is relatively modest. We suspected that the early benefit might be much greater. If so, taking aspirin as soon as possible after 'warning symptoms' event could be very worthwhile.'

The team - from Oxford (UK), University Medical Center Utrecht (Netherlands), University Duisburg-Essen (Germany), and Lund University (Sweden) - therefore revisited the individual patient data from twelve trials (about 16,000 people) of aspirin for long-term secondary prevention - that is, to prevent a further stroke - and data on about 40,000 people from three trials of aspirin in treatment of acute stroke.

They found that almost all of the benefit of aspirin in reducing the risk of another stroke was in the first few weeks, and that aspirin also reduced the severity of these early strokes. Rather than the 15% overall reduction in longer-term risk reported previously in these trials, aspirin reduced the early risk of a fatal or disabling stroke by about 70-80% over the first few days and weeks.

Professor Rothwell said: 'Our findings confirm the effectiveness of urgent treatment after TIA and minor stroke - and show that aspirin is the most important component. Immediate treatment with aspirin can substantially reduce the risk and severity of early recurrent stroke. This finding has implications for doctors, who should give aspirin immediately if a TIA or minor stroke is suspected, rather than waiting for specialist assessment and investigations.'

'The findings also have implications for public education. Public information campaigns have worked in getting more people to seek help sooner after a major stroke, but have been less effective in people who have had minor strokes or TIAs. Many don't seek medical attention at all and many delay for a few days. Half of recurrent strokes in people who have a TIA happen before they seek medical attention for the TIA. Encouraging people to take aspirin if they think they may have had a TIA or minor stroke - experiencing sudden-onset unfamiliar neurological symptoms - could help to address this situation, particularly if urgent medical help is unavailable.'

Dr Dale Webb, Director of Research and Information at the Stroke Association, said: 'A TIA is a medical emergency and urgent neurological assessment must always be sought. We welcome this research which shows that taking aspirin after TIA can dramatically reduce the risk and severity of further stroke. The findings suggest that anyone who has stroke symptoms, which are improving while they are awaiting urgent can, if they are able, take one dose of 300 mg .

'The research findings are also timely, as the stroke community is currently working to develop a new set of national clinical guidelines on stroke.'

Explore further: Study points to challenges, hopes of helping vulnerable patients avoid stroke

More information: Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials, is published in the Lancet, DOI: 10.1016/S0140-6736(16)30511-6

Related Stories

Study points to challenges, hopes of helping vulnerable patients avoid stroke

May 10, 2016
A new study published in the New England Journal of Medicine today demonstrates both the importance and the challenge of treating people who are at high risk of a stroke.

Resistance to aspirin tied to more severe strokes

February 23, 2015
People who exhibit a resistance to aspirin may be more likely to have more severe strokes than people who still respond to the drug, according to a study released today that will be presented at the American Academy of Neurology's ...

Adding clopidogrel to aspirin therapy reduces risk of second stroke

February 11, 2013
Adding a second drug to aspirin therapy reduced the risk of a second stroke in the weeks after Chinese patients had a minor ischemic (due to a clot) stroke or a transient ischemic attack (TIA), according to research presented ...

Stroke happens regardless of age, race or gender

May 16, 2016
May is National Stroke Awareness Month, and according to the Centers for Disease Control and Prevention, every 40 seconds, someone in the U.S. has a stroke.

When is an aspirin a day to prevent heart attacks too risky?

December 10, 2015
We've known for a long time that aspirin can help prevent damage from a heart attack or a stroke if taken during one of those events. In fact, you might have seen ads about how aspirin can be lifesaving during a heart attack.

Recommended for you

Heart researchers develop a new, promising imaging technique for cardiac arrhythmias

February 22, 2018
Every five minutes in Germany alone, a person dies of sudden cardiac arrest or fibrillation, the most common cause of death worldwide. This is partly due to the fact that doctors still do not fully understand exactly what ...

Scientists use color-coded tags to discover how heart cells develop

February 22, 2018
UCLA researchers used fluorescent colored proteins to trace how cardiomyocytes—cells in heart muscle that enable it to pump blood—are produced in mouse embryos. The findings could eventually lead to methods for regenerating ...

Beetroot juice supplements may help certain heart failure patients

February 22, 2018
Beetroot juice supplements may help enhance exercise capacity in patients with heart failure, according to a new proof-of-concept study. Exercise capacity is a key factor linked to these patients' quality of life and even ...

'Beetroot pill' could help save patients from kidney failure after heart X-ray

February 22, 2018
Beetroot may reduce the risk of kidney failure in patients having a heart x-ray, according to research led by Queen Mary University of London.

Women once considered low risk for heart disease show evidence of previous heart attack scars

February 20, 2018
Women who complain about chest pain often are reassured by their doctors that there is no reason to worry because their angiograms show that the women don't have blockages in the major heart arteries, a primary cause of heart ...

Heart attack symptoms often misinterpreted in younger women

February 20, 2018
Young women who report heart attack symptoms are more likely to have them dismissed by their providers as not heart related, a new study led by the Yale School of Public Health (YSPH) finds.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.