To Load or Not to Load? Aspirin Loading in Acute Ischemic Stroke: A Study of Clinical Outcomes

Su, Tse‐Hsuan; Chan, Yi-Ling; Lee, Jiann-Der; Lee, Meng; Lin, Li-Mei; Wen, Yu-Wen; Lee, Tsong‐Hai

doi:10.1016/j.jstrokecerebrovasdis.2016.06.016

Cited by 4 publications

(6 citation statements)

References 29 publications

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“…The optimal aspirin dosage in the context of secondary prophylaxis of AIS is still debatable. [17][18][19][20][21] Large trials and meta-analyses acknowledge that there is no significant difference between groups receiving low versus high doses of aspirin regarding serious vascular events or death rates. [18][19][20][21][22] However, none of these studies found a clear correlation between different doses of aspirin and increased risk of HT.…”

Section: Discussionmentioning

confidence: 99%

“…This finding agrees with those of recent retrospective cohort studies, 4,5 suggesting poorer outcomes in patients with HT, even if asymptomatic. [18][19][20][21][22] As a non-randomized and non-blinded retrospective cohort study, our study had several limitations regarding selection and allocation biases. The aspirin dosage choice was based on individual clinical judgment.…”

Section: Discussionmentioning

confidence: 99%

“…Our results suggest that assessing the risk of HT could be useful when determining the optimal aspirin dose during hospital admission for ischemic stroke. The optimal aspirin dosage in the context of secondary prophylaxis of AIS is still debatable 17–21 . Large trials and meta-analyses acknowledge that there is no significant difference between groups receiving low versus high doses of aspirin regarding serious vascular events or death rates 18–22 .…”

Section: Discussionmentioning

confidence: 99%

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In-Hospital Aspirin Dose as a Risk Factor for Hemorrhagic Transformation in Patients Not Treated With Thrombolysis

et al. 2023

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Background: Aspirin is widely used as secondary prophylaxis for acute ischemic stroke. However, its influence on the risk of spontaneous hemorrhagic transformation (HT) is still unclear. Predictive scores of HT have been proposed. We hypothesized that an increased aspirin dose might be harmful in patients at a high risk of HT. This study aimed to analyze the relationship between in-hospital daily aspirin dose (IAD) and HT in patients with acute ischemic stroke. Methods: We conducted a retrospective cohort study of patients admitted to our comprehensive stroke center between 2015 and 2017. The attending team defined IAD. All included patients underwent either computed tomography or magnetic resonance imaging within 7 days of admission. The risk of HT was assessed using the predictive score of HT in patients not undergoing reperfusion therapies. Regression models were used to evaluate the correlations between HT and IAD. Results: A total of 986 patients were included in the final analysis. The prevalence of HT was 19.2%, and parenchymatous hematomas type-2 (PH-2) represented 10% (n=19) of these cases. IAD was not associated with HT (P=0.09) or PH-2 (P=0.06) among all patients. However, in patients at a higher risk for HT (patients not undergoing reperfusion therapies ≥3), IAD was associated with PH-2 (odds ratio 1.01,95% CI 1.001-1.023,P=0.03) in an adjusted analysis. Taking 200 versus 300 mg aspirin was protective against PH-2 (odds ratio 0.102, 95% CI 0.018-0.563, P=0.009). Conclusion: An increased in-hospital aspirin dose is associated with intracerebral hematoma in patients at a high risk of HT. Stratifying the risk of HT may lead to individualized daily aspirin dose choices. However, clinical trials on this topic are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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In-Hospital Aspirin Dose as a Risk Factor for Hemorrhagic Transformation in Patients Not Treated With Thrombolysis

et al. 2023

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“…There were minor variations between stroke care provider recommendations, with very few patients receiving a loading dose of ASA before initiation of daily low-dose ASA. There is evidence from the non-traumatic stroke literature suggesting that the practice of giving a baseline loading dose of ASA is associated with improved outcomes, 16 and good evidence that early initiation of dual antiplatelet therapy with ASA and clopidogrel, or ASA and ticagrelor is superior to ASA alone for secondary prevention. [17][18][19] However, the value of these strategies for stroke prevention in the BCVI population is unknown.…”

Section: E307mentioning

confidence: 99%

Management of blunt cerebrovascular injuries at a Canadian level 1 trauma centre: Are we meeting the grade?

D’Souza

Birnie

et al. 2022

cjs

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Background: Untreated blunt cerebrovascular injuries (BCVIs) are associated with high rates of death and disability due to stroke. We assessed alignment of clinical practice at our centre with current recommendations for management of BCVIs and examined rates of new and recurrent in-hospital stroke. Methods:We retrospectively reviewed the BC Trauma Registry to identify all adult (age > 18 yr) patients with trauma with BCVIs at the largest level 1 trauma centre in

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“…34 Few patients in their study received a loading dose of ASA, or dual antiplatelet therapy. Although evidence supports these practices for nontraumatic stroke, 35,36 their role remains unclear for stroke prevention in BCVI.…”

Section: Treatment and Outcomesmentioning

confidence: 99%

Work-up and Management of Asymptomatic Extracranial Traumatic Vertebral Artery Injury

MacLean

Touchette

Duda

et al. 2022

Can. J. Neurol. Sci.

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Background: Non-penetrating head and neck trauma is associated with extracranial traumatic vertebral artery injury (eTVAI) in approximately 1–2% of cases. Most patients are initially asymptomatic but have an increased risk for delayed stroke and mortality. Limited evidence is available to guide the management of asymptomatic eTVAI. As such, we sought to investigate national practice patterns regarding screening, treatment, and follow-up domains. Methods: A cross-sectional, electronic survey was distributed to members of the Canadian Neurosurgical Society and Canadian Spine Society. We presented two cases of asymptomatic eTVAI, stratified by injury mechanism, fracture type, and angiographic findings. Screening questions were answered prior to presentation of angiographic findings. Survey responses were analyzed using descriptive statistics. Results: One hundred-eight of 232 (46%) participants, representing 20 academic institutions, completed the survey. Case 1: 78% of respondents would screen for eTVAI with computed topography angiography (CTA) (97%), immediately (88%). The majority of respondents (97%) would treat with aspirin (89%) for 3–6 months (46%). Respondents would follow up clinically (89%) or radiographically (75%), every 1–3 months. Case 2: 73% of respondents would screen with CTA (96%), immediately (88%). Most respondents (94%) would treat with aspirin (50%) for 3–6 months (35%). Thirty-six percent of respondents would utilize endovascular therapy. Respondents would follow up clinically (97%) or radiographically (89%), every 1–3 months. Conclusion: This survey of Canadian practice patterns highlights consistency in the approach to screening, treatment, and follow-up of asymptomatic eTVAI. These findings are relevant to neurosurgeons, spinal surgeons, stroke neurologists, and neuro-interventionalists.

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To Load or Not to Load? Aspirin Loading in Acute Ischemic Stroke: A Study of Clinical Outcomes

Cited by 4 publications

References 29 publications

In-Hospital Aspirin Dose as a Risk Factor for Hemorrhagic Transformation in Patients Not Treated With Thrombolysis

In-Hospital Aspirin Dose as a Risk Factor for Hemorrhagic Transformation in Patients Not Treated With Thrombolysis

Management of blunt cerebrovascular injuries at a Canadian level 1 trauma centre: Are we meeting the grade?

Work-up and Management of Asymptomatic Extracranial Traumatic Vertebral Artery Injury

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