Prior Aspirin Therapy, Subsequent Stroke Severity and Mortality and Relationship with Cardiovascular Risk Factors in Patients Admitted to Hospital with Acute Stroke

Abstract

Objective: To investigate whether the prior use of aspirin has an association with the severity and mortality of subsequent stroke and its relationship with cardiovascular risk factors. Methods: This was a study of 296 patients, with a median age of 75 years, admitted to hospital with acute stroke. Data were collected on demography, risk factors, stroke syndromes, infarct size, parameters of stroke severity and acute-phase and 90-day mortality. Patients were categorised into aspirin (n = 95) and non-aspirin (n = 201) groups, depending on whether or not they had received prior aspirin therapy. Analysis was performed to study the relationship between prior aspirin therapy, cardiovascular risk factors, previous stroke and stroke mortality. Results: Patients in the aspirin group were more disabled prior to stroke (p < 0.001) and had a higher incidence of prior stroke (p < 0.001) and ischaemic heart disease (p < 0.001). There was insignificantly higher acute-phase and 90-day mortality in the aspirin group (p = 0.13 and 0.30, respectively) in all patients. There was significantly higher acute-phase mortality among patients with ischemic strokes in the aspirin group [p = 0.02; relative risk (RR) 2.26, 95% confidence interval (CI) 1.14–4.50] and non-significantly higher 90-day mortality (p = 0.08; RR 1.50, 95% CI 0.96–2.35). The significance did not persist when previous stroke was controlled for. Patients with pre-existing cardiac failure on aspirin had higher mortality (0.001) than did patients in the non-aspirin group. Conclusions: There was a trend for higher mortality in patients with ischaemic strokes on prior aspirin therapy. This may have been due to a higher incidence of cardiovascular disease in the aspirin group. Patients with cardiac failure on aspirin had higher mortality following a stroke.

Antiplatelet therapy in diabetic ischemic stroke patients: associated factors and outcomes

“…Although the current study showed a significant relationship between DM as a risk factor for stroke and mortality after stroke attack, we found that previous treatment with an antiplatelet agent was associated with a small but not significant reduction in inhospital mortality in diabetic stroke patients. This finding is compatible with the results of previous reports that studied the effect of aspirin use among all patients admitted with acute ischemic stroke [11,30]. However, it contrasts with another study that found a lower mortality rate 4 weeks after the stroke attack in all ischemic stroke subtypes, but not among patients with strokes due to small vessel occlusion (p = 0.8) [31].…”

“…August 2011, 1:48 PM [25]. Moreover, some studies have observed that previous aspirin use among the patients studied had no effect on stroke severity or outcomes [10,11]. In addition, several reasons for inadequate use of antiplatelet therapy in diabetic patients have been mentioned by some prescribers and include: difficulties in applying guidelines to individuals, patient resistance or contraindication to taking aspirin, risk of hemorrhagic stroke and gastrointestinal bleeding, and prioritization of other issues and medication, especially in cases of patient noncompliance [26].…”

“…Therefore, antiplatelet therapy, as a primary and secondary prevention of vascular events including stroke, is recommended by the American Diabetes Association for diabetic patients, especially those who are over 50 y old, or who have at least one additional risk factor, such as a family history of vascular disease, hypertension, smoking, dyslipidemia or albuminuria [7]. Some studies have reported that patients who have an ischemic stroke while taking aspirin have less severe strokes than those not on such pretreatment, resulting in more favorable outcomes [8,9], but others have suggested that aspirin has no effect on stroke severity or its outcomes [10,11].…”

Impact of the Additive Effect of Angiotensin‐Converting Enzyme Inhibitors and /or Statins with Antiplatelet Medication on Mortality After Acute Ischaemic Stroke

“…Some studies reported that patients who suffer ischaemic stroke while taking aspirin have less severe strokes and more favourable outcomes [3,4]. However, others suggested that aspirin has no effect on stroke severity or its outcomes [5,6]. In the Women’s Health study, a randomized primary prevention clinical trial, 10‐year follow‐up of 39,876 apparently healthy women health professionals to evaluate the benefits of aspirin in the primary prevention of stroke and cardiovascular diseases, was performed.…”

Pre-Stroke Use of Antihypertensives, Antiplatelets, or Statins and Early Ischemic Stroke Outcomes

“…Our results should be interpreted in light of the limitations of our study, as patients on antiplatelets are known to have more cardiovascular risk factors [18]. We also have limited information on stroke subtypes, which can be associated with different degrees of stroke severity [19].…”