What is the recommended duration of aspirin 160mg daily for a patient of Chinese descent with a history of stroke?

Duration of Aspirin 160mg After Stroke

Aspirin 160mg is given as a single loading dose only, not as a duration of therapy. After the initial 160mg loading dose, patients transition immediately to a lower maintenance dose of 81-325mg daily (most commonly 75-100mg daily) that continues indefinitely for secondary stroke prevention. 1

Acute Phase: Loading Dose

• Administer aspirin 160mg as a one-time loading dose immediately after brain imaging excludes intracranial hemorrhage and dysphagia screening is passed 1
• This loading dose should be given within 48 hours of stroke onset for maximum benefit 1
• The 160mg dose ensures rapid and complete inhibition of platelet aggregation in the acute setting 2

Transition to Maintenance Therapy

After the single 160mg loading dose, immediately switch to maintenance dosing:

• Continue aspirin 81-325mg daily indefinitely (most guidelines recommend 75-100mg daily for optimal benefit-to-risk ratio) 1, 3
• This maintenance therapy should continue lifelong or until an alternative antithrombotic regimen is started 1

Special Consideration for Chinese Patients with Minor Stroke

For patients of Chinese descent with minor stroke (NIHSS 0-3) or high-risk TIA, consider dual antiplatelet therapy instead:

• Loading: Aspirin 160-325mg + clopidogrel 300-600mg within 24 hours of symptom onset 1, 2, 4
• Maintenance: Aspirin 75-100mg daily + clopidogrel 75mg daily for exactly 21 days only 1, 2, 4
• After 21 days: Switch to single antiplatelet therapy (aspirin 75-100mg daily OR clopidogrel 75mg daily) indefinitely 1, 4

This recommendation is particularly relevant given the CHANCE trial was conducted exclusively in Chinese patients and demonstrated superior efficacy of dual therapy (8.2% vs 11.7% stroke recurrence, HR 0.68, p<0.001) without increased major bleeding 1, 5

Critical Timing Points

• Day 1: Single 160mg aspirin loading dose 1
• Day 2 onward: Maintenance dose 81-325mg daily (typically 75-100mg) 1, 3
• If dual therapy indicated: Continue both agents for exactly 21 days, then monotherapy indefinitely 1, 4

Common Pitfalls to Avoid

• Do not continue 160mg daily - this is a loading dose only, not a maintenance dose 1
• Do not delay the loading dose beyond 48 hours, as efficacy is time-dependent 1, 6
• Do not use enteric-coated formulation for the loading dose, as it delays absorption when rapid platelet inhibition is needed 3
• Do not extend dual antiplatelet therapy beyond 21-30 days in minor stroke patients, as bleeding risk outweighs benefit (HR for major hemorrhage 2.32, p=0.02) 1, 4