Is ecospirin (aspirin) 150mg suitable for 3 months in lacunar stroke management?

Aspirin 150mg for 3 Months in Lacunar Stroke

Yes, aspirin 150mg can be used for lacunar stroke, but current guidelines recommend aspirin 75-100mg daily for long-term secondary prevention, not specifically limited to 3 months. The dose of 150mg falls within the acceptable range, though it is higher than the optimal recommended dose for long-term use.

Acute Phase Management (First 24-48 Hours)

• Aspirin should be initiated within 24-48 hours after stroke onset once intracranial hemorrhage is ruled out on neuroimaging 1
• A loading dose of 160-325mg is recommended at initiation 1, 2
• For patients with minor lacunar stroke (NIHSS ≤3), dual antiplatelet therapy (DAPT) with aspirin 81mg + clopidogrel 75mg should be initiated within 12-24 hours, with loading doses of aspirin 160-325mg and clopidogrel 300-600mg 1, 3

Duration of Dual Antiplatelet Therapy (If Applicable)

• DAPT is only indicated for 21-30 days in minor stroke or high-risk TIA, then transition to single antiplatelet therapy 1, 3
• For lacunar strokes specifically, long-term dual antiplatelet therapy (beyond 21-30 days) is NOT recommended as it significantly increases bleeding risk without reducing recurrent stroke 4
• The SPS3 trial definitively showed that adding clopidogrel to aspirin in lacunar stroke patients nearly doubled major hemorrhage risk (2.1% vs 1.1% per year) and increased mortality without reducing recurrent stroke 4

Long-Term Maintenance Therapy (After Acute Phase)

• Single antiplatelet therapy should be continued indefinitely, not just 3 months 1
• Recommended options include:
  • Aspirin 75-100mg daily (preferred dose range) 1
  • Clopidogrel 75mg daily 1
  • Aspirin/extended-release dipyridamole 25/200mg twice daily 1

Evidence Specific to Lacunar Stroke

• Any single antiplatelet agent is effective for secondary prevention after lacunar stroke compared to placebo, reducing recurrent ischemic stroke risk (RR 0.48) 5
• Aspirin specifically reduced stroke recurrence in lacunar stroke patients (HR 0.67) in long-term follow-up 6
• There is no evidence that one single antiplatelet agent is superior to another for lacunar stroke prevention 5
• Among recurrent strokes in lacunar stroke patients, 71% are also lacunar strokes, suggesting persistent small vessel disease 4

Dosing Considerations for Your Question

The 150mg dose you mentioned:

• Falls within the acceptable range of 75-325mg daily recommended by guidelines 1
• Is higher than the optimal 75-100mg range preferred by most recent guidelines 1
• Should be continued indefinitely, not stopped at 3 months 1

Critical Pitfalls to Avoid

• Do not stop antiplatelet therapy at 3 months - lacunar stroke requires lifelong secondary prevention as small vessel disease is chronic 1
• Do not use long-term dual antiplatelet therapy beyond the initial 21-30 days in minor stroke, as this doubles bleeding risk and increases mortality in lacunar stroke patients 4
• Do not use anticoagulation for lacunar stroke unless there is a separate indication like atrial fibrillation 1
• Consider reducing the dose to 75-100mg daily for optimal long-term benefit-risk ratio 1

Recommended Approach

1. If this is acute lacunar stroke (within 24 hours) with NIHSS ≤3: Start DAPT with aspirin 160-325mg loading + clopidogrel 300-600mg loading, then aspirin 75-100mg + clopidogrel 75mg daily for 21 days 1, 3

2. If beyond acute phase or NIHSS >3: Use single antiplatelet therapy with aspirin 75-100mg daily indefinitely 1

3. If already on aspirin 150mg: This is acceptable but consider reducing to 75-100mg daily for long-term use, and continue indefinitely, not just 3 months 1