Aspirin after 'mini stroke' reduces further risk

Taking aspirin immediately when patients experience stroke-like symptoms may considerably reduce the risk of a fatal stroke over the next few days and weeks, a new study has claimed.
Aspirin is already given to people who have had a stroke or transient ischaemic attack (TIA), often called a 'mini-stroke', to prevent further strokes after they have been assessed in hospital and in the longer-term, reducing the subsequent stroke risk by about 15 per cent.
However, based on a previous study, the team suspected that the benefits of more immediate treatment with aspirin could be much greater.
"The risk of a major stroke is very high immediately after a TIA or a minor stroke (about 1,000 times higher than the background rate), but only for a few days," said lead researcher Peter Rothwell, a stroke expert from the University of Oxford in the UK.

"We showed previously that urgent medical treatment with a 'cocktail' of different drugs could reduce the one-week risk of stroke from about 10 per cent to about 2 per cent, but we didn't know which component of the 'cocktail' was most important," said Rothwell.
"We suspected that the early benefit might be much greater. If so, taking aspirin as soon as possible after 'warning symptoms' event could be very worthwhile," he said.

The team from Oxford, University Medical Centre Utrecht in the Netherlands, University Duisburg-Essen in Germany and Lund University in Sweden revisited the individual patient data from twelve trials (about 16,000 people) of aspirin for long-term secondary prevention - that is, to prevent a further stroke - and data on about 40,000 people from three trials of aspirin in treatment of acute stroke.

They found that almost all of the benefit of aspirin in reducing the risk of another stroke was in the first few weeks, and that aspirin also reduced the severity of these early strokes.
Rather than the 15 per cent overall reduction in longer-term risk reported previously in these trials, aspirin reduced the early risk of a fatal or disabling stroke by about 70-80 per cent over the first few days and weeks.
"Our findings confirm the effectiveness of urgent treatment after TIA and minor stroke - and show that aspirin is the most important component," Rothwell said.
"Immediate treatment with aspirin can substantially reduce the risk and severity of early recurrent stroke. This finding has implications for doctors, who should give aspirin immediately if a TIA or minor stroke is suspected, rather than waiting for specialist assessment and investigations," he added.

The research was published in the journal Lancet.