From the Guidelines
Low-dose aspirin (81mg daily) is not recommended for primary stroke prevention in low-risk patients. For individuals without a history of cardiovascular disease, significant risk factors, or prior stroke, the potential bleeding risks typically outweigh the modest benefits, as stated in the guidelines for the primary prevention of stroke by the American Heart Association/American Stroke Association 1. The guidelines clearly indicate that aspirin is not useful for preventing a first stroke in persons at low risk (Class III; Level of Evidence A) 1.
Key Considerations
- The use of aspirin for cardiovascular prophylaxis is recommended for persons whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment (a 10-year risk of cardiovascular events of 6% to 10%) (Class I; Level of Evidence A) 1.
- Aspirin (81 mg daily or 100 mg every other day) can be useful for prevention of a first stroke among women whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment (Class IIa; Level of Evidence B) 1.
- For most truly low-risk patients, lifestyle modifications including regular physical activity, maintaining healthy weight, not smoking, limiting alcohol consumption, and following a heart-healthy diet are more appropriate first-line approaches to stroke prevention without the associated bleeding risks of aspirin therapy.
Individualized Approach
The decision to use aspirin for stroke prevention should always be individualized and made in consultation with your healthcare provider who can evaluate your complete cardiovascular risk profile. If you have specific risk factors such as atrial fibrillation, diabetes, hypertension, or elevated cholesterol, your doctor might consider aspirin therapy after a thorough risk assessment 1.
From the Research
Stroke Prevention with 81mg Aspirin for Low-Risk Patients
- The use of aspirin for stroke prevention in low-risk patients is a topic of ongoing debate, with various studies providing conflicting evidence 2, 3, 4, 5, 6.
- A study published in the American Family Physician in 2003 discusses the primary prevention of stroke, including lifestyle modifications and measures to control blood pressure, cholesterol levels, diabetes mellitus, and atrial fibrillation 2.
- Another study published in The American Journal of Medicine in 2006 suggests that the appropriate dose of aspirin for the primary prevention of stroke in men and women has not been established, but doses of 75 and 100 mg/day have been ineffective in men and women 3.
- A review of the literature published in Current Medical Research and Opinion in 2006 found that low-dose aspirin (75-325 mg daily) is commonly used for the secondary prevention of cardiovascular and cerebrovascular events, but the optimal dose for primary and secondary prevention is uncertain 4.
- A study published in The Annals of Pharmacotherapy in 2010 found that low-dose (50-81 mg daily) aspirin is insufficient for some indications, and that aspirin dosing must be individualized according to indication 5.
- A systematic review published in The Cochrane Database of Systematic Reviews in 2004 found that antiplatelet therapy with aspirin cannot be recommended for primary prevention in patients with elevated blood pressure, as the magnitude of benefit is negated by a harm of similar magnitude 6.
Aspirin Dosing for Stroke Prevention
- The appropriate dose of aspirin for stroke prevention is uncertain, but studies suggest that doses of 75 and 100 mg/day may be ineffective in men and women 3.
- A review of the literature found that low-dose aspirin (75-325 mg daily) is commonly used for the secondary prevention of cardiovascular and cerebrovascular events, but the optimal dose for primary and secondary prevention is uncertain 4.
- A study published in The Annals of Pharmacotherapy in 2010 found that aspirin dosing must be individualized according to indication, and that higher doses are indicated for stroke prevention in atrial fibrillation (325 mg) and acute ischemic stroke patients (160-325 mg) 5.
Risks and Benefits of Aspirin Therapy
- Aspirin therapy is associated with a risk of major bleeding, which must be weighed against the potential benefits of stroke prevention 3, 4, 5, 6.
- A study published in The Cochrane Database of Systematic Reviews in 2004 found that antiplatelet therapy with aspirin cannot be recommended for primary prevention in patients with elevated blood pressure, as the magnitude of benefit is negated by a harm of similar magnitude 6.