Long-term prophylaxis with aspirin after an ischaemic stroke or transient ischaemic event (TIA) reduces the incidence of further vascular events by about 22%.37
Reduction of mortality by aspirin during the acute phase of a stroke has recently been examined in two very large randomised trials. 38,39 aspirin, given during the first two to four weeks, led to an additional saving of about 1 death per 100 patients - ‘a modest but worthwhile improvement’. (40)
aspirin is not however to be recommended in either cardio-embolic stroke, or haemorrhagic stroke. Anticoagulation is the treatment of choice in the first, and the control of blood pressure in the second.
The differential diagnosis between these and an ischaemic lesion is of course difficult. If computerised tomography (a CT scan) can be performed and if this indicates an ischaemic lesion, aspirin should be given as early as possible, but otherwise it is best witheld during the acute phase of a cerebral lesion.
1897 - Hoffman produced acetyl salicylic acid
1974 - First randomised trial of aspirin and MI reported
1980 - FDA approves the use of aspirin after a stroke
1985 - FDA approves aspirin after heart attack
1996 - FDA approves aspirin for use in suspected MI