Risk of Hemorrhagic Stroke With Aspirin Use

Abstract

Background-Low-dose aspirin is an important therapeutic option in the secondary prevention of myocardial infarction (MI) and ischemic stroke, especially in light of its unique cost-effectiveness and widespread availability. In addition, based on the results of a number of large studies, aspirin is also widely used in the primary prevention of MI. This review provides an update of the available data to offer greater clarity regarding the risks of aspirin with respect to hemorrhagic stroke, as well as insights regarding patient selection to minimize the risk of this complication. Summary of Review-In the secondary prevention of cardiovascular, cerebrovascular, and ischemic events, the evidence supports that the benefits of aspirin treatment significantly outweigh the risk of a major hemorrhage. The evidence from primary prevention of MI studies, including that from the recent Women's Health Study evaluation of aspirin use in healthy women, demonstrate that the increased risk for hemorrhagic stroke is small, is comparable to the secondary prevention studies, and fails to achieve statistical significance. A reasonable estimate of the risk of hemorrhagic stroke associated with the use of aspirin in primary prevention patients is 0.2 events per 1000 patient-years, which is comparable to estimates of the risk associated with the use of aspirin in secondary prevention patients. Conclusions-When considering whether aspirin is appropriate, the absolute therapeutic cardiovascular benefits of aspirin must be balanced with the possible risks associated with its use, with the most serious being hemorrhagic stroke.

The association of the 1-tubulin Q43P polymorphism with intracerebral hemorrhage in men

“…Aspirin is a drug of choice to lower the risk of thrombotic cerebroand cardiovascular events, but some patients receiving aspirin therapy suffer from intracerebral hemorrhage. 24,25 In our study, we show that the TUBB1 Q43P polymorphism increases the risk of ICH. Thus, an interesting issue would be to test the prevalence of this polymorphism in patients taking aspirin who had hemorrhagic strokes to evaluate whether the TUBB1 Q43P polymorphism should be taken into account when prescribing aspirin prophylaxis.…”

Aspirin and tension-type headache

“…The incidence of upper gastrointestinal tract complications (i.e., bleeding or perforation) in the general population is estimated to be 1-2 cases per 1000 persons/year, with a case fatality rate ranging from 5% to 10%. These results can be found in observational studies involving patients in long-term use of low-dose Aspirin for prevention of cardiovascular diseases [39,40]. Major and minor bleeding complications can occur as well [41].…”

Is Antiplatelet Therapy for the Prevention of Ischemic Stroke Associated with the Prognosis of Intracerebral Hemorrhage?

“…It has been used for primary and secondary prevention of myocardial infarction and ischemic stroke [6]. A recent study reported that 30% of the patients with ICH were taking aspirin [10] and that the use of aspirin therapy was associated with a two-fold increase in the risk of ICH in patients with cerebrovascular diseases [5,6,10]. Therefore, we focused on the effect of antiplatelet therapy on outcomes at the time of hospital discharge of 253 patients with ICH.…”