BACKGROUND: Low-dose aspirin is an important therapeutic option in the secondary prevention of myocardial infarction (MI) and ischemic stroke, especially in light of its unique cost-effectiveness and widespread availability. In addition, based on the results of a number of large studies, aspirin is also widely used in the primary prevention of MI. This review provides an update of the available data to offer greater clarity regarding the risks of aspirin with respect to hemorrhagic stroke, as well as insights regarding patient selection to minimize the risk of this complication. SUMMARY OF REVIEW: In the secondary prevention of cardiovascular, cerebrovascular, and ischemic events, the evidence supports that the benefits of aspirin treatment significantly outweigh the risk of a major hemorrhage. The evidence from primary prevention of MI studies, including that from the recent Women's Health Study evaluation of aspirin use in healthy women, demonstrate that the increased risk for hemorrhagic stroke is small, is comparable to the secondary prevention studies, and fails to achieve statistical significance. A reasonable estimate of the risk of hemorrhagic stroke associated with the use of aspirin in primary prevention patients is 0.2 events per 1000 patient-years, which is comparable to estimates of the risk associated with the use of aspirin in secondary prevention patients. CONCLUSIONS: When considering whether aspirin is appropriate, the absolute therapeutic cardiovascular benefits of aspirin must be balanced with the possible risks associated with its use, with the most serious being hemorrhagic stroke.
BACKGROUND: Low-dose aspirin is an important therapeutic option in the secondary prevention of myocardial infarction (MI) and ischemic stroke, especially in light of its unique cost-effectiveness and widespread availability. In addition, based on the results of a number of large studies, aspirin is also widely used in the primary prevention of MI. This review provides an update of the available data to offer greater clarity regarding the risks of aspirin with respect to hemorrhagic stroke, as well as insights regarding patient selection to minimize the risk of this complication. SUMMARY OF REVIEW: In the secondary prevention of cardiovascular, cerebrovascular, and ischemic events, the evidence supports that the benefits of aspirin treatment significantly outweigh the risk of a major hemorrhage. The evidence from primary prevention of MI studies, including that from the recent Women's Health Study evaluation of aspirin use in healthy women, demonstrate that the increased risk for hemorrhagic stroke is small, is comparable to the secondary prevention studies, and fails to achieve statistical significance. A reasonable estimate of the risk of hemorrhagic stroke associated with the use of aspirin in primary prevention patients is 0.2 events per 1000 patient-years, which is comparable to estimates of the risk associated with the use of aspirin in secondary prevention patients. CONCLUSIONS: When considering whether aspirin is appropriate, the absolute therapeutic cardiovascular benefits of aspirin must be balanced with the possible risks associated with its use, with the most serious being hemorrhagic stroke.
Authors: Mark H Eckman; Alexandru Costea; Mehran Attari; Jitender Munjal; Ruth E Wise; Carol Knochelmann; Matthew L Flaherty; Pete Baker; Robert Ireton; Brett M Harnett; Anthony C Leonard; Dylan Steen; Adam Rose; John Kues Journal: Am Heart J Date: 2017-08-23 Impact factor: 4.749
Authors: Margarete A Wichmann; Karen J Cruickshanks; Cynthia M Carlsson; Rick Chappell; Mary E Fischer; Barbara E K Klein; Ronald Klein; Carla R Schubert Journal: Alzheimer Dis Assoc Disord Date: 2016 Apr-Jun Impact factor: 2.703
Authors: Andrew T Chan; Nadir Arber; John Burn; Whay Kuang Chia; Peter Elwood; Mark A Hull; Richard F Logan; Peter M Rothwell; Karsten Schrör; John A Baron Journal: Cancer Prev Res (Phila) Date: 2011-11-14