(Stroke. 1996;27:756-760.)
© 1996 American Heart Association, Inc.
Articles |
Aspirin in Ischemic Cerebrovascular Disease
How Strong Is the Case for a Different Dosing Regimen?
From the Departments of Pharmacology and Medicine, University of Chieti "G. D'Annunzio" School of Medicine (Italy) (C.P.), and the Hematology Section, Medical and Research Services, Seattle Veterans Hospital, and the University of Washington, Seattle (G.J.R.).
Correspondence to Professor Carlo Patrono, Cattedra di Farmacologia I, Università degli Studi "G. D'Annunzio," Via dei Vestini, 31, 66013 Chieti, Italy.
Background A vast consensus exists in defining a narrow range of recommended daily doses of aspirin, ie, 75 to 160 mg, for the prevention of myocardial infarction, stroke, and vascular death in patients with different manifestations of coronary heart disease. In contrast, for patients with cerebrovascular disease, a much larger degree of uncertainty still exists, with recommendations ranging from 30 to 1300 mg daily.
Summary of Comment The contention that higher doses of aspirin (650 to 1300 mg) are more effective than lower doses in stroke prevention is based on indirect and selective comparisons of different trial data, mini-meta-analyses, or subgroup analyses of individual trials. In the absence of definitive evidence from direct randomized comparisons of low-dose versus high-dose aspirin in trials of adequate size to detect a moderate difference between the two, the biological hypotheses that underpin the suggestion of greater efficacy of higher aspirin doses in cerebrovascular disease patients are reviewed and disputed. Practical implications of the use of higher doses of aspirin are also assessed on the basis of theoretical calculations of absolute benefits and risks.
Conclusions Until additional information from ongoing trials is available, good clinical practice should dictate the use of the lowest dose of aspirin shown effective in the prevention of stroke and death in patients with ischemic cerebrovascular disease, ie, 75 mg daily.
Key Words: antiplatelet therapy • aspirin • stroke prevention
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