Does low-dose acetylsalicylic acid prevent stroke after carotid surgery? A double-blind, placebo-controlled randomized trial.

Lindblad, Bengt; Persson, Nils H.; Takolander, R; Bergqvist, David

doi:10.1161/01.str.24.8.1125

Cited by 158 publications

(75 citation statements)

References 18 publications

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“…Another trial enrolled 232 subjects to 75 mg aspirin or placebo started before CE and continued for 6 months (Class I). 19 Although likely underpowered, this trial demonstrated fewer strokes without recovery in those subjects randomized to aspirin compared with placebo at 1 month (zero strokes vs 7 strokes, p ϭ 0.003) and 6 months (2 strokes vs 11 strokes, p ϭ 0.01).…”

Section: What Is the Ideal Dose Of Aspirin Preoperatively In Patientsmentioning

confidence: 86%

Carotid endarterectomy—An evidence-based review [RETIRED]

Chaturvedi¹,

Bruno²,

Feasby³

et al. 2005

Neurology

466

143

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Abstract-Objective:To assess the efficacy of carotid endarterectomy for stroke prevention in asymptomatic and symptomatic patients with internal carotid artery stenosis. Additional clinical scenarios, such as use of endarterectomy combined with cardiac surgery, are also reviewed. Methods: The authors selected nine important clinical questions. A systematic search was performed for articles from 1990 (the year of the last statement) until 2001. Additional articles from 2002 through 2004 were included using prespecified criteria. Two reviewers also screened for other relevant articles from 2002 to 2004. Case reports, review articles, technical studies, and single surgeon case series were excluded. Results: For several questions, high quality randomized clinical trials had been completed. Carotid endarterectomy reduces the stroke risk compared to medical therapy alone for patients with 70 to 99% symptomatic stenosis (16% absolute risk reduction at 5 years). There is a smaller benefit for patients with 50 to 69% symptomatic stenosis (absolute risk reduction 4.6% at 5 years). There is a small benefit for asymptomatic patients with 60 to 99% stenosis if the perioperative complication rate is low. Aspirin in a dose of 81 to 325 mg per day is preferred vs higher doses (650 to 1,300 mg per day) in patients undergoing endarterectomy. Conclusions: Evidence supports carotid endarterectomy for severe (70 to 99%) symptomatic stenosis (Level A). Endarterectomy is moderately useful for symptomatic patients with 50 to 69% stenosis (Level B) and not indicated for symptomatic patients with Ͻ50% stenosis (Level A). For asymptomatic patients with 60 to 99% stenosis, the benefit/risk ratio is smaller compared to symptomatic patients and individual decisions must be made. Endarterectomy can reduce the future stroke rate if the perioperative stroke/death rate is kept low (Ͻ3%) (Level A). Low dose aspirin (81 to 325 mg) is preferred for patients before and after carotid endarterectomy to reduce the rate of stroke, myocardial infarction, and death (Level A). NEUROLOGY 2005;65:794-801 Extracranial internal carotid artery stenosis accounts for 15 to 20% of ischemic strokes, depending on the population studied. Carotid endarterectomy (CE) is the most frequently performed operation to prevent stroke.The last statement from the American Academy of Neurology regarding CE was published in 1990. 1Since then, several multicenter trials have been completed and this statement reflects an update on major developments since 1990.Methods. Vascular neurologists were appointed by the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. A literature search was performed using Ovid Medline for relevant articles published from 1990 to 2001 using the following key words: carotid endarterectomy, carotid stenosis, carotid artery diseases, clinical trials. Further de-

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Section: What Is the Ideal Dose Of Aspirin Preoperatively In Patientsmentioning

confidence: 86%

Carotid endarterectomy—An evidence-based review [RETIRED]

Chaturvedi¹,

Bruno²,

Feasby³

et al. 2005

Neurology

466

143

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“…2,3 Aspirin in a dose of 75 mg/d was shown to be effective in reducing the risk of acute myocardial infarction (MI) or death in patients with unstable angina 4 and chronic stable angina, 5 as well as in reducing stroke or death in patients with transient cerebral ischemia 6 and the risk of postoperative stroke after carotid endarterectomy. 7 In the European Stroke Prevention Study (ESPS)-2, aspirin 25 mg twice daily was effective in reducing the risks of stroke and of the composite outcome stroke or death in patients with prior stroke or transient ischemic attack (TIA). 8 Moreover, in the European Collaboration on Low-dose Aspirin in Polycythemia vera (ECLAP) trial, 9 aspirin 100 mg/d was effective in preventing thrombotic complications in patients with polycythemia vera, despite a higher-than-normal platelet count.…”

Section: The Optimal Dose Of Aspirinmentioning

confidence: 99%

Aspirin: Promise and Resistance in the New Millennium

Patrono

Rocca

2008

ATVB

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Abstract-Although conceived at the end of the 19th century, aspirin remains the gold standard of antiplatelet therapy.Approximately 100 randomized clinical trials have established its efficacy and safety in the prevention of myocardial infarction, ischemic stroke, and vascular death among high-risk patients treated for a few weeks, at one end of the spectrum, and in low-risk subjects treated up to 10 years at the other. Despite this wealth of data, several issues continue to be debated concerning the use of aspirin as an antiplatelet agent, and novel opportunities appear on the horizon for this 110-year-old drug. These issues include: (1) the optimal dose for cardiovascular prophylaxis; (2) the uncertain threshold of cardiovascular risk for its use in primary prevention; (3) the apparent gender-related difference in its cardioprotective effects; (4) the increasingly popular theme of aspirin "resistance"; (5) the opportunities of chemoprevention in colorectal cancer; and (6) the renewed interest in aspirin as an analgesic agent in osteoarthritic patients at high cardiovascular risk. The aim of this review is to address these issues by integrating our current understanding of the molecular mechanism of action of the drug with the results of clinical trials and epidemiological studies of aspirin as an antiplatelet drug. A lthough conceived at the end of the 19th century, aspirin remains the gold standard of antiplatelet therapy. Approximately 100 randomized clinical trials have established its efficacy and safety in the prevention of myocardial infarction, ischemic stroke, and vascular death among highrisk patients treated for a few weeks, at one end of the spectrum, and in low-risk subjects treated up to 10 years at the other. 1,2 Despite this wealth of data, several issues continue to be debated concerning the use of aspirin as an antiplatelet agent, and novel opportunities appear on the horizon for this 110-year-old drug. These issues include: (1) the optimal dose for cardiovascular prophylaxis; (2) the uncertain threshold of cardiovascular risk for its use in primary prevention; (3) the apparent gender-related difference in its cardioprotective effects; (4) the increasingly popular theme of aspirin "resistance"; (5) the opportunities of chemoprevention in colorectal cancer; and (6) the renewed interest in aspirin as an analgesic agent in osteoarthritic patients at high cardiovascular risk.The aim of this review is to address these issues by integrating our current understanding of the molecular mechanism of action of the drug with the results of clinical trials and epidemiological studies of aspirin as an antiplatelet drug. The Optimal Dose of AspirinPlacebo-controlled randomized trials have shown that aspirin is an effective antithrombotic agent when used long term in doses ranging between 50 and 100 mg/d, and there is a suggestion that it is effective in doses as low as 30 mg/d. 2,3 Aspirin in a dose of 75 mg/d was shown to be effective in reducing the risk of acute myocardial infarction (MI) or death in pati...

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“…Interestingly, when surgeons are not aware if aspirin was used or not, they often cannot distinguish, based on the type of bleeding, patients on aspirin from those who have discontinued. 40 The American College of Chest Physicians guidelines for the perioperative management of antithrombotic therapy have identified a group of surgeries and procedures that appear to be associated with a high risk for bleeding in the context of perioperative anticoagulant and antiplatelet drug use. 41 An alternative approach coming from a joint national consensus defined the interventions at greater risk of bleeding within an array of different surgeries or invasive procedures (Table 1).…”

Section: Bleeding Riskmentioning

confidence: 99%