From the Guidelines
Taking a low-dose aspirin daily (typically 75-100 mg) can help protect against stroke, particularly for people who have already had a stroke or transient ischemic attack (TIA), or who have certain cardiovascular risk factors, as evidenced by a significant reduction in total stroke from 2.54% to 2.08% per year (P = .002) 1.
Key Points to Consider
- Aspirin works by inhibiting platelets from forming clots that can block blood vessels in the brain, thereby reducing the risk of ischemic vascular events.
- The decision to take daily aspirin should be based on individual risk factors and made in consultation with a healthcare provider, considering the potential benefits and risks, including an increased risk of gastrointestinal bleeding 1.
- For those who would benefit, the protection begins shortly after starting the regimen and continues as long as the medication is taken regularly.
- People with bleeding disorders, aspirin allergies, or certain gastrointestinal conditions should avoid aspirin therapy due to increased bleeding risks.
- Side effects can include stomach irritation and bleeding, so taking aspirin with food may help reduce these issues.
Important Considerations for Aspirin Therapy
- Aspirin is just one component of stroke prevention; controlling blood pressure, managing cholesterol, not smoking, maintaining a healthy weight, and regular physical activity are equally important preventive measures.
- Daily aspirin doses of 75–100 mg seem to be as effective as higher doses for long-term treatments, with a significant reduction in coronary events from 5.3% to 4.3% per year (P < .0001) 1.
- There is no evidence of different aspirin effects in women and men, making it a viable option for both genders 1.
From the Research
Aspirin and Stroke Prevention
- The use of aspirin for primary prevention of cardiovascular disease, including stroke, is a topic of ongoing debate 2, 3.
- Some studies suggest that low-dose aspirin (75-100 mg/day) may reduce the risk of cardiovascular events, including stroke, in certain populations 2, 4.
- However, other studies have found that the benefit of aspirin in primary prevention may be offset by an increased risk of bleeding, particularly in patients without a history of cardiovascular disease 3, 5.
- A 2009 study found that aspirin reduces the risk of stroke in women, but not in men, in the context of primary prevention 5.
- A 2010 review of the literature on aspirin dosing for stroke prevention found that the minimum effective dose of aspirin varies depending on the indication, with higher doses (160-325 mg/day) recommended for acute ischemic stroke and atrial fibrillation 6.
Benefits and Risks of Aspirin Therapy
- The benefits of aspirin therapy in primary prevention must be weighed against the risks, including bleeding complications 2, 3, 4.
- A 2020 review found that the benefit-to-risk ratio of aspirin use in primary prevention is debated, and that individualized assessment of benefits and harms is necessary 4.
- The risk of bleeding associated with aspirin therapy must be carefully considered, particularly in patients with a history of bleeding disorders or those taking other medications that increase the risk of bleeding 3, 5, 4.
Individualized Approach to Aspirin Therapy
- A nuanced approach to aspirin therapy in primary prevention is recommended, taking into account the individual patient's cardiovascular risk profile and other factors 4.
- Clinicians should assess the risk of major adverse cardiovascular events (MACE) and base their decision to prescribe aspirin on this assessment, considering the risk of bleeding and patient preferences 4.
- Aspirin therapy may be recommended for patients at high risk of MACE who do not have a prohibitive risk of bleeding, and in the majority of cases after initiation of properly titrated statin therapy 4.