Aspirin and intracerebral hemorrhage

Abstract

SummaryFor the past 3 decades, aspirin has been widely used for prevention of ischemic stroke and myocardial infarction. Although the evidence supporting the effectiveness of aspirin in prevention of vascular events is clear, data regarding the risk of acute and recurrent intracerebral hemorrhage related to the use of this medication have been conflicting. We review past and contemporary data on aspirin use in relation to intracerebral hemorrhage.A spirin, or acetylsalicylic acid (ASA), was synthesized in 1897 by the German chemist Felix Hoffmann.1 Its original and current indication is for control of pain and inflammation. Seventy years after its initial formulation, ASA was shown to block platelet aggregation by inhibition of thromboxane A 2 .2 Now it is well-known that ASA is effective in prevention of myocardial infarction (MI) and ischemic stroke (IS) and has been used in that capacity for the past 3 decades.3 Since its expanded utilization, the risk of bleeding has been a concern for physicians. For neurologists, this concern particularly involves balancing the risk of intracerebral hemorrhage (ICH) with the benefits afforded by IS prevention. The effectiveness of ASA in prevention of IS is indisputable. A meta-analysis of 18 trials reported a 23% reduction in IS risk with antiplatelet therapy. 4 Because of its widespread availability and low cost, ASA is the most widely used drug in the world.5 However, studies regarding the effect of prior ASA use on ICH development, growth, and outcome have found conflicting results. The authors present past data and the most recent information on ASA use and ICH. PharmacologyThe antithrombotic property of ASA is related to its inhibition of the cyclooxygenase (COX)

Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective

“…Inhibition of PGHS-1 in platelets creates a disruption of the equilibrium in favour of PGI 2 , with a cardioprotective anti-aggregant effect, manifested due to low dose-use of aspirin [85,156,159]. Since the plasma half-life of aspirin is 20 min, the enucleate platelets cannot produce any new PGHS-1; so the effect of aspirin remains as long as the platelets survive (10 days) [160]. Unlike platelets, in endothelial cells the PGHS-1 is restored within a short period of time after being inhibited by aspirin thus without much affecting the PGI 2 production [161].…”

“…have shown a lower risk of bleeding event for clopidogrel monotherapy compared to aspirin [208]. Having said this, it should be mentioned that the advantage of aspirin in secondary prevention of IS is greater over its risk for ICH [160]. Since a large population is exposed to NSAIDs, these drugs should be prescribed judiciously by the clinicians keeping in mind the risk-benefit thresholds which determine the safety profiles.…”

Clinical Characteristics, Treatment Outcomes, and its Predictors Among Hospitalized Stroke Patients in Ambo University Referral Hospital, West Ethiopia: A Retrospective Hospital-Based Study

“…6,7 Unfortunately, LMICs face challenges due to a lack of resources, awareness, and technical capacity to accurately diagnose and manage the stroke. 5,8 The risk factors for stroke are diverse depending on patient outcomes. Hypertension, cardiac disease, and diabetes were commonly reported risk factors of stroke in the world.…”

Effect of Premorbid Antiplatelet Medication Use on Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: A Propensity Score-matched Study

“…Inhibition of platelet function may be counterproductive in SAH as there is a theoretical risk of hemorrhage exacerbation through inhibiting platelet aggregation, additionally, this may increase the risk of rebleeding and increase the risk of other bleeding complications after surgical procedures. The reported risk of ASA-associated intracerebral hemorrhage, however, has varied from one study to another but is consistently low [23]. In our cohort, ASA users had a non-significant trend towards greater SAH clot thickness and IPH volumes, a phenomenon that requires exploration in larger studies.…”