This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wilterdink, J. L. Articles by Hansen, M. D. Search for Related Content PubMed PubMed Citation Articles by Wilterdink, J. L. Articles by Hansen, M. D. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID Medline Plus Health Information Blood Thinners Stroke

(Stroke. 2001;32:2836.)
© 2001 American Heart Association, Inc.

Original Contributions

Effect of Prior Aspirin Use on Stroke Severity in the Trial of Org 10172 in Acute Stroke Treatment (TOAST)

Janet L. Wilterdink, MD; Birgitte Bendixen, MD; Harold P. Adams, Jr, MD; Robert F. Woolson, PhD; William R. Clarke, PhD Michael D. Hansen, MS for the TOAST Investigators

From the Department of Clinical Neurosciences, Brown Medical School, Providence, RI (J.L.W.); Department of Neurology, Albert Einstein College of Medicine, New York, NY (B.B.); and Department of Neurology (H.P.A.) and College of Public Health (R.F.W., W.R.C., M.D.H.), University of Iowa College of Medicine, Iowa City.

Correspondence to Janet L. Wilterkink, MD, Department of Neurology, 110 Lockwood St, No. 324, Providence, RI 02903. E-mail wilterdink{at}brown.edu

Background and Purpose— Although the efficacy of aspirin in reducing stroke incidence is clear, its role in reducing stroke severity is disputed. This study compares stroke severity between patients who did or did not take aspirin in the week before stroke and enrollment in the Trial of Org 10172 in Acute Stroke Treatment (TOAST).

Methods— Of 1275 patients randomized, 509 reported aspirin use in the week before stroke; 766 did not. Clinical stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Supplementary Motor Examination (SME) at trial entry and at 3 months. Using these scales, we compared the categorization of stroke severity (mild, moderate, and severe) and mean scores between aspirin users and nonusers.

Results— The difference in distribution of baseline NIHSS scores was statistically significant between aspirin users and nonusers (P=0.006), with a greater percentage of milder strokes among aspirin users. The difference in mean baseline NIHSS scores was also significantly lower in aspirin users (8.2) and nonusers (9.3) (P=0.003). The distribution of baseline SME scores and mean SME scores also showed lower stroke severity in aspirin users than in nonusers (P=0.048 and P=0.004, respectively). At 3 months, differences in stroke severity measured by the SME but not the NIHSS remained statistically significant. Seven-day and 3-month mortality did not differ significantly.

Conclusions— In this study aspirin use is associated with milder clinical deficits at stroke onset. These deficits may affect prognosis and influence response to treatment. Future clinical trials should ensure that prestroke aspirin use is comparable in study groups.

Key Words: aspirin • stroke outcome • stroke prevention

This article has been cited by other articles:

				H.-F. Li, X.-D. Pan, N. Sanossian, and B. Ovbiagele Premorbid antiplatelet use and ischemic stroke outcomes. Neurology, November 14, 2006; 67(9): 1723 - 1723. [Full Text] [PDF]

				N. Sanossian, J. L. Saver, and B. Ovbiagele Aspirin and Stroke Severity Stroke, November 1, 2006; 37(11): 2660 - 2660. [Full Text] [PDF]

				S. Ricci, S. Lewis, P. Sandercock, and on behalf of the IST Collaborative Group Previous Use of Aspirin and Baseline Stroke Severity: An Analysis of 17 850 Patients in the International Stroke Trial Stroke, July 1, 2006; 37(7): 1737 - 1740. [Abstract] [Full Text] [PDF]

				S. Kumar, S. Savitz, G. Schlaug, L. Caplan, and M. Selim Antiplatelets, ACE inhibitors, and statins combination reduces stroke severity and tissue at risk Neurology, April 25, 2006; 66(8): 1153 - 1158. [Abstract] [Full Text] [PDF]

				N. Sanossian, J. L. Saver, V. Rajajee, S. L. Selco, D. Kim, T. Razinia, and B. Ovbiagele Premorbid antiplatelet use and ischemic stroke outcomes Neurology, February 14, 2006; 66(3): 319 - 323. [Abstract] [Full Text] [PDF]

				B. Ovbiagele, C. S. Kidwell, S. Starkman, S. L. Selco, V. Rajajee, T. Razinia, and J. L. Saver Angiotensin 2 type 2 receptor activity and ischemic stroke severity Neurology, September 27, 2005; 65(6): 851 - 854. [Abstract] [Full Text] [PDF]

				R. W. Baumgartner, C. Sidler, M. Mosso, D. Georgiadis, and L. R. Caplan Ischemic Lacunar Stroke in Patients With and Without Potential Mechanism Other Than Small-Artery Disease * Editorial Comment Stroke, March 1, 2003; 34(3): 653 - 659. [Abstract] [Full Text] [PDF]