Information about the efficacy of low-dose aspirin in the primary prevention of stroke is derived from meta-analyses and results of recent major trials, most of which have been conducted in populations with mean ages younger than 70 years. 1 - 3 Its major adverse effect is an increased bleeding tendency. Despite some recent unfavorable findings, it continues to be widely used for primary and secondary prevention of stroke. Trial Registration Identifier: ISRCTN83772183Īspirin is an antiplatelet agent that has been used in low doses (75-100 mg/d) for the prevention of cardiovascular events. These findings may have particular relevance to older individuals prone to developing intracranial bleeding after head trauma. Hemorrhagic stroke was recorded in 49 individuals (0.5%) assigned to aspirin compared with 37 individuals (0.4%) in the placebo group (HR, 1.33 95% CI, 0.87-2.04).Ĭonclusions and Relevance This study found a significant increase in intracranial bleeding with daily low-dose aspirin but no significant reduction of ischemic stroke. This occurred by an increase in a combination of subdural, extradural, and subarachnoid bleeding with aspirin compared with placebo (59 individuals vs 41 individuals HR, 1.45 95% CI, 0.98-2.16). However, a statistically significant increase in intracranial bleeding was observed among individuals assigned to aspirin (108 individuals ) compared with those receiving placebo (79 individuals HR, 1.38 95% CI, 1.03-1.84). Aspirin did not produce a statistically significant reduction in the incidence of ischemic stroke (hazard ratio, 0.89 95% CI, 0.71-1.11). Results Among 19 114 older adults (10 782 females median age, 74 years), 9525 individuals received aspirin and 9589 individuals received placebo. Outcomes were assessed by review of medical records. Main Outcomes and Measures Stroke and stroke etiology were predetermined secondary outcomes and are presented with a focus on prevention of initial stroke or intracranial bleeding event. Interventions Daily 100-mg enteric-coated aspirin or matching placebo. This analysis was completed from August 2021 to March 2023. Recruitment took place between 20, and participants were followed up for a median (IQR) of 4.7 (3.6-5.7) years. Participants were older adults free of symptomatic cardiovascular disease. Objective To establish the risks of ischemic stroke and intracranial bleeding among healthy older people receiving daily low-dose aspirin.ĭesign, Setting, and Participants This secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) randomized, double-blind, placebo-controlled trial of daily low-dose aspirin was conducted among community-dwelling people living in Australia or the US. The balance between potential reduction of ischemic stroke events and increased intracranial bleeding has not been established in older individuals. Importance Low-dose aspirin has been widely used for primary and secondary prevention of stroke. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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