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 stroke 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 minor stroke (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 patients 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 medical attention can, if they are able, take one dose
of 300 mg aspirin.
'The
research findings are also timely, as the stroke community is currently working
to develop a new set of national clinical guidelines on stroke.'
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