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 Warlow, C. Search for Related Content PubMed PubMed Citation Articles by Warlow, C.

(Stroke. 2002;33:2137.)
© 2002 American Heart Association, Inc.

Controversies in Stroke

Aspirin Should Be First-Line Antiplatelet Therapy in the Secondary Prevention of Stroke

Charles Warlow, MD, FRCP

From the University of Edinburgh, Edinburgh, Scotland, UK.

Correspondence to Dr Charles Warlow, University of Edinburgh, Edinburgh, Scotland, UK. E-mail cpw@skull.dcn.ed.ac.uk

Key Words: aspirin • clopidogrel • dipyridamole • stroke prevention

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Long-term management after an ischemic stroke (or transient ischemic attack [TIA]) boils down to reducing not just the high risk of a stroke but also the risk of other serious events due to similar underlying vascular pathology, such as myocardial infarction (MI) and sudden cardiac death.¹ Therefore, minimizing causal vascular risk factors (blood pressure, cholesterol, smoking, and diabetes) and lifestyle modification (diet, exercise) are crucial, along with carotid endarterectomy for a few carefully selected patients. But what about doing something about the blood, such as antithrombotic therapy?

Aspirin Works!

A vast amount of randomized data supports the use of antiplatelet drugs to prevent serious vascular events (stroke, MI, and vascular death) in a wide range of patients at high vascular risk (eg, stroke survivors, MI survivors, claudicants). This has been summarized recently by the Antithrombotic Trialists’ collaboration.² The bottom line is that antiplatelet drugs reduce the odds of such an event by 22%. The effect is more or less identical in patients who have only had a stroke or TIA or if aspirin alone, which makes up two thirds of the data, is considered. Aspirin alone after stroke/TIA reduces the odds of a serious vascular event by 17%.³ Antiplatelet drugs reduce the risk of not only the composite outcome of stroke, MI, and vascular death but also of each of the 3 components separately, more so for nonfatal than fatal events. Undoubtedly, aspirin works in the secondary prevention of stroke. Furthermore, the cost is minimal, and the risks are low (remember that . . . [Full Text of this Article]

This article has been cited by other articles:

				P. B. Gorelick, D. Richardson, M. Kelly, S. Ruland, E. Hung, Y. Harris, S. Kittner, and S. Leurgans Aspirin and Ticlopidine for Prevention of Recurrent Stroke in Black Patients: A Randomized Trial JAMA, June 11, 2003; 289(22): 2947 - 2957. [Abstract] [Full Text] [PDF]