From the Guidelines
Patients who have experienced a transient ischemic attack (TIA) should take aspirin, typically at a dose of 81-325 mg daily, as recommended by the most recent guidelines. After a TIA, immediate initiation of antiplatelet therapy is recommended, with aspirin being the most common first-line option, as supported by the 2018 guidelines for the early management of patients with acute ischemic stroke 1. For higher-risk patients, doctors may prescribe a combination of aspirin (25 mg) and extended-release dipyridamole (200 mg) twice daily, or clopidogrel 75 mg daily as alternatives.
Key Considerations
- Aspirin works by inhibiting platelet aggregation, which reduces the formation of blood clots that could cause a stroke.
- It's essential to take aspirin with food to minimize gastrointestinal side effects.
- Patients should also address other stroke risk factors such as high blood pressure, diabetes, smoking, and high cholesterol.
- If you experience side effects like stomach pain or unusual bleeding, contact your healthcare provider, but don't stop taking the medication without medical advice.
Evidence-Based Recommendations
- The 2018 guidelines for the early management of patients with acute ischemic stroke recommend administering aspirin in patients with AIS within 24 to 48 hours after onset 1.
- The American Heart Association/American Stroke Association guidelines also recommend the use of antiplatelet agents, including aspirin, for patients with noncardioembolic ischemic stroke or TIA 1.
- The selection of an antiplatelet agent should be individualized based on patient risk factor profiles, cost, tolerance, and other clinical characteristics 1.
From the Research
Aspirin Therapy for Patients with TIA
- The use of aspirin in patients with Transient Ischemic Attack (TIA) is a common practice to prevent further ischemic events 2, 3, 4, 5.
- Studies have shown that the combination of aspirin and clopidogrel may be more effective in reducing the risk of recurrent ischemic stroke than aspirin alone, but it also increases the risk of bleeding 2, 4, 5.
- A meta-analysis of randomized controlled trials found that dual antiplatelet therapy (DAPT) with aspirin and clopidogrel reduced the risk of recurrent stroke by 26% and major adverse cardiovascular events by 24% compared to aspirin monotherapy, but increased the risk of moderate or severe bleeding 5.
- The efficacy and safety of aspirin plus clopidogrel versus aspirin alone may vary depending on the patient's hypertension status, with patients without hypertension potentially benefiting more from DAPT 6.
Benefits and Risks of Aspirin Therapy
- Benefits of aspirin therapy in patients with TIA include:
- Reduced risk of recurrent ischemic stroke
- Reduced risk of major adverse cardiovascular events
- Risks of aspirin therapy in patients with TIA include:
- Increased risk of bleeding, including moderate or severe bleeding
- Potential interaction with other medications, such as clopidogrel
Clinical Considerations
- The decision to use aspirin in patients with TIA should be based on individual patient characteristics, including their risk of recurrent ischemic stroke and bleeding 3, 4, 5.
- Patients with a history of hypertension may not benefit as much from DAPT with aspirin and clopidogrel as those without hypertension 6.
- Close monitoring of patients on aspirin therapy is necessary to minimize the risk of bleeding and other adverse events 2, 4, 5.