section name header

Evidence summaries

Antiplatelet Therapy for Acute Ischaemic Stroke

Aspirin (160 to 300 mg/day) started within 48 hours of onset of presumed ischaemic stroke reduces the risk of early recurrent stroke and improves long-term outcome. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 8 trials with a total of 41 483 patients with acute ischaemic stroke. Trials included participants randomised from within 6 hours to 6 days of stroke onset. A significant proportion of participants were over 70 years of age. Two trials testing aspirin 160 mg to 300 mg once daily started within 48 hours of onset contributed 98% of the data. The maximum follow-up was six months. With treatment, there was a significant decrease in death or dependency at the end of follow-up (OR 0.95, 95% CI 0.91 to 0.99; 4 trials, n=41 291). In absolute terms, 13 more patients were alive and independent at the end of follow-up for every 1000 patients treated (NNT 79). Antiplatelet therapy was associated with an excess of 2 symptomatic intracranial haemorrhages for every 1000 patients treated (NNH 574), but this was offset by a reduction of 7 recurrent ischaemic strokes for every 1000 patients treated.

The following decision support rules contain links to this evidence summary:

    References

    • Sandercock PA, Counsell C, Tseng MC et al. Oral antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev 2014;3():CD000029. [PubMed].

Primary/Secondary Keywords