Aspirin for primary prevention of stroke in individuals without cardiovascular disease—A meta-analysis

Abstract

Background The benefits of aspirin for primary prevention of stroke are uncertain. Methods We performed a cumulative meta-analysis of trials investigating aspirin for primary prevention of cardiovascular disease with a focus on stroke. We assessed the effects of aspirin on non-fatal stroke, hemorrhagic stroke, non-fatal myocardial infarction, all-cause mortality, cardiovascular mortality, major gastrointestinal bleeding, and an analysis of net clinical effect, in populations without a history of clinical or subclinical cardiovascular disease. Summary of review results Among 11 trials (157,054 participants), aspirin was not associated with a statistically significant reduction in non-fatal stroke (odds ratio, 0.94; 95% CI, 0.85 to 1.04) but was associated with an increased risk of hemorrhagic stroke (odds ratio, 1.29; 95% CI, 1.06 to 1.56). Aspirin was not associated with a statistically significant reduction in all-cause mortality (odds ratio, 0.97; 95% CI, 0.92 to 1.03) or cardiovascular mortality (odds ratio, 0.94; 95% CI, 0.85 to 1.03). Aspirin was associated with a reduction in non-fatal myocardial infarction (odds ratio, 0.80; 95% CI, 0.69 to 0.94) and an increased risk of major gastrointestinal bleeding (odds ratio, 1.83; 95% CI, 1.43 to 2.35). Using equal weighting for non-fatal events and major bleeding, we observed no net clinical benefit with aspirin use for primary prevention. Conclusion Our meta-analysis reports no benefit of aspirin for primary stroke prevention.

Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients

“…Generally speaking, the risk of hemorrhagic stroke is well acknowledged to increase in patients taking aspirin. Therefore, it is plausible that aspirin could reduce the risk of ischemic stroke recurrence while it could cause significantly more fatal hemorrhagic stroke 37 , 38 compared with nicametate. However, as time to recurrence has been also included in the survival time from the date if first-time stroke, through recurrence, and then to death from cerebrovascular disease, it is not good not to take time to recurrence into account.…”

“…Third, according to the mechanism and evidence-based researches, the treatment with aspirin for prevention on primary or secondary stroke may increase the risk of hemorrhagic stroke 37 , 38 . However, the cause of death ascertained by Health and Welfare Data Science Center (HWDC), in light of the regulation for open data use, only 26 and 36 brief classifications of cause of death were provided for before 2007 and 2008 onward, respectively (see Supplementary Table 1 ).…”

An observational study of T2-weighted white matter hyperintensities on magnetic resonance imaging of the internal auditory meatus and brain: ignore or not?

“…Finally, although preventive medication was not the aim of our study, it is worth mentioning that while one could suggest routine use of antiplatelet medication in certain patients with white matter hyperintensities on MRI and co-existing risk factors, the current evidence does not support using antiplatelets as a primary prevention for stroke. 23,24…”

Should Senior Citizens Take Aspirin Daily to Prevent Heart Attacks or Strokes?

“…4 In the nearly 30 years since the Physicians Health Study was reported, it has become very clear that doses of aspirin even as low as 81 mg (a single baby aspirin tablet) per day could cause significant gastrointestinal bleeding. [5][6][7][8][9][10][11][12][13][14] The risk of gastrointestinal bleeding with aspirin is much higher in individuals 65 years and older 5,13 (Table 1). Saad et al 5 estimated that the risk of major bleeding nearly doubled with each decade of age even without the use of aspirin.…”