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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 11 studies with a total of 42 226 subjects with acute ischaemic stroke. 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 96% 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; 7 studies, n=42 034). 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.

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    References

    • Minhas JS, Chithiramohan T, Wang X, et al. Oral antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev 2022;1(1):CD000029 [PubMed]

Primary/Secondary Keywords