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(Stroke. 2006;37:2326.)
© 2006 American Heart Association, Inc.

Original Contributions

Randomized Controlled Trial of Acetylsalicylic Acid in Aneurysmal Subarachnoid Hemorrhage

The MASH Study

Walter M. van den Bergh, MD on behalf of the MASH Study Group

From the MASH Study, The Netherlands.

Correspondence to Walter M. van den Bergh, MD, PhD, Department of Neurology, Room G03.228, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail w.m.vandenbergh{at}umcutrecht.nl

Background and Purpose— A previous systematic review of randomized trials suggested a positive effect of antiplatelet therapy in patients with aneurysmal subarachnoid hemorrhage (SAH). We performed a randomized controlled trial to assess whether acetylsalicylic acid (ASA) reduces the risk of delayed ischemic neurological deficit (DIND) in patients with SAH.

Methods— Criteria for inclusion were aneurysm treatment within 4 days after SAH. Trial medication (14 daily suppositories with 100 mg ASA or placebo) was started within 12 hours after aneurysm treatment. Analysis for the primary outcome event DIND was made according to the "on-treatment" principle and for the secondary outcome measures "poor outcome" and "nonexcellent outcome" according to the "intention-to-treat" principle.

Results— Inclusion was stopped after the second interim analysis, when 161 of the planned 200 patients were included, because by then the chances of a positive effect were negligible. At the final analysis, ASA did not reduce the risk of DIND (hazard ratio, 1.83; 95% CI, 0.85 to 3.9). The relative risk reduction for poor outcome was 21% (relative risk, 0.79; 95% CI, 0.38 to 1.6).

Conclusions— ASA given after aneurysm treatment does not appreciably reduce the occurrence of DIND.

Key Words: aspirin • ischemia • platelets • randomized controlled trials • subarachnoid hemorrhage

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