From the Guidelines
Aspirin can be given in a lacunar infarct, and its administration is recommended within 24 to 48 hours after onset, as stated in the 2018 guidelines for the early management of patients with acute ischemic stroke 1. The recommended dose of aspirin is between 160 to 300 mg, as established by large clinical trials and confirmed by a Cochrane review of aspirin trials 1.
- The safety and benefit of aspirin in the treatment of patients with acute ischemic stroke (AIS) have been well established.
- In patients who are unable to swallow, rectal or nasogastric administration of aspirin is appropriate.
- For patients treated with IV alteplase, aspirin administration is generally delayed until 24 hours later, but may be considered earlier in the presence of concomitant conditions that require aspirin therapy.
- The timing of initiation of antiplatelet therapy should be made on an individual level, balancing risk versus benefit, as the evidence suggests that early initiation of antiplatelet therapy may not increase the risk of hemorrhage 1.
- It is essential to monitor for potential side effects of aspirin, including gastrointestinal bleeding, and consider gastroprotective agents in high-risk patients.
- Alternative antiplatelet agents, such as clopidogrel, may be considered in patients with a contraindication to aspirin, but the evidence for their use in lacunar infarct is limited 1.
From the Research
Aspirin in Lacunar Infarct
- Aspirin can be given in a lacunar infarct, as evidenced by studies that have investigated the effectiveness of antiplatelet therapy for secondary prevention in patients with lacunar stroke 2, 3, 4, 5.
- A study published in 2012 found that patients with recent lacunar strokes who received aspirin alone had a lower risk of major hemorrhage compared to those who received dual antiplatelet therapy with aspirin and clopidogrel 2.
- Another study published in 2015 found that any single antiplatelet agent, including aspirin, was associated with a significant reduction in recurrence of any stroke and ischemic stroke in patients with lacunar stroke 3.
- A 2003 study noted that antiplatelet therapy and risk factor modification are the cornerstones in secondary prevention after a lacunar infarct 4.
- A 2019 study found that aspirin significantly reduced stroke recurrence in patients with lacunar stroke, with a hazard ratio of 0.67 (95% CI 0.45-0.99) 5.
Considerations for Aspirin Use
- The use of aspirin in lacunar infarct should be considered in the context of the patient's overall risk profile and medical history 2, 3, 4, 5.
- Dual antiplatelet therapy with aspirin and another antiplatelet agent may not be necessary for long-term stroke prevention in patients with lacunar stroke 2, 3.
- Aspirin may be used as part of a comprehensive treatment plan that includes risk factor modification and other therapies to reduce the risk of recurrent stroke and other cardiovascular events 4, 5.