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(Stroke. 2004;35:2760.)
© 2004 American Heart Association, Inc.

Letters to the Editor

Aspirin for Stroke Prevention Taken in the Evening?

Institute of Nursing and Clinical Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary

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

To the Editor:

We read the article by Yip et al¹ with great interest, in which they demonstrated that platelet activation significantly increases in acute ischemic stroke and subtantially decreases thereafter. The lesser long-term pharmacodynamic potency of aspirin relative to clopidogrel raises the prospect of the need for more effective antiplatelet agents or a synergistic combination therapy for stroke prevention in the future.¹ Their results are very impressive and raise some ideas, particularly associated with the prevention’s procedures.

According to World Health Organization data, in 1996 4.6 million people in the world died because of cerebrovascular manifestation of atherothrombosis.² In Hungary, nearly 18 000 people suffer stroke every year, half of whom die within a year. In cases of both cardiovascular and cerebrovascular diseases the significant decrease of morbidity/mortality can only be achieved by increasing the effect of prevention. A major form of secondary prevention is the administration of drugs inhibiting the aggregation of platelets.

Aspirin is one of the most common, useful, and inexpensive tools for prevention. The effect of aspirin on platelets is irreversible lasting for the duration of the platelet’s life span (10 days). Aspirin-mediated inhibition of platelet function occurs within 60 minutes of ingestion.³

The incidence of stroke assessed by onset of clinical symptoms exhibits a marked circadian variation with a peak period during the morning. Stroke usually occurs unexpectedly and more frequently in early morning hours (between 5 to 12 PM; see Figure) when the aggregability of thrombocytes is higher.⁴ Increased platelet . . . [Full Text of this Article]

Hon-Kan Yip, MD; Shun-Sheng Chen, MD, PhD Mien-Cheng Chen, MD

Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan, R.O.C.