Stroke remains a common and costly problem worldwide, but substantial advances have been made in recent decades in understanding stroke mechanisms, risk factors, and therapies. Because thrombosis plays an important role in the pathogenesis of ischemic stroke, drugs that interfere with hemostasis and clot formation such as anticoagulants and platelet antiaggregants commonly are used in the management of cerebrovascular disease.
Considerable evidence supports the use of certain antithrombotic drugs in stroke prevention. However, because of limited supportive data, the use of these agents in patients with acute ischemic stroke remains controversial.
Most strokes are caused by a sudden blockage of an artery in the brain (called an ischaemic stroke) that is usually due to a blood clot. Immediate treatment with antiplatelet drugs such as aspirin may prevent new clots from forming and hence improve recovery after stroke. However antiplatelet drugs may also cause bleeding in the brain which could offset any benefits. This review of 12 trials, including 43,041 participants, showed very clearly that aspirin, at a dose of 160 mg to 300 mg daily, started within 48 hours of the onset of stroke symptoms, saved lives and reduced the risk of further stroke occurring in the first two weeks.
Aspirin also increased the chances of being alive and independent and improved the chances of making a complete recovery from this stroke. The risk of serious bleeding was very low. Almost of all the evidence in this review comes from trials of aspirin. There is no reliable evidence on the effects of other antiplatelet drugs in acute stroke.
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