- The use of acetylsalicylic acid (ASS) is the standard therapy for secondary prevention following atherotrombotic brain infarction or myocardial infarction.
Due to the risk of bleeding complications, platelet inhibitors are not recommended for primary prevention in patients with cerebrovascular risk. According to Goltz L et al. (2014) there are inconsistent data concerning the use of ASS for primary prevention in patients with increased cardiovascular risk and cerebrovascular risk.
(L Goltz, U Bodechtel, T Siepmann: Statins and ASS for primary prevention of cardiovascular and cerebrovascular disease. DMW 2014; 139(6):283-286)
Thank you for your short answers. In addition: The new oral anticoagulants are slightly more effective than coumarin and significantly reduce the risk of intracranial hemorrhage. They offer the opportunity to bring more patients with atrial fibrillation at
risk for stroke into anticoagulation particularly those on ASS therapy.
No. Nowadays physycians changed, and they are not more recommended.And I personaly believe that the real power of new drugs it's only well known after one decade in the market.
the best evidence so far was collected by goldstein regarding the use of aspirin:
1. The use of aspirin for cardiovascular (including but not specific to stroke) prophylaxis is recommended for persons whose risk is sufficiently high for the benefits to outweigh the risks associated with treat- ment (a 10-year risk of cardiovascular events of 6% to 10%) (Class I; Level of Evidence A).
2. Aspirin (81 mg daily or 100 mg every other day) can be useful for prevention of a first stroke among women whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment (Class IIa; Level of Evidence B).
3. Aspirin is not useful for preventing a first stroke in persons at low risk (Class III; Level of Evidence A).
this can be found in this article:
Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011. pp. 517–84.
also regarding aspirin as primary stroke prevention:
McCarthy M. FDA questions use of aspirin for primary prevention of stroke and heart attack. BMJ. 2014;:g3168.
Dear Hugo Rodrigues, thank you very much!
In addition: Platelet inhibitors are effective in the secondary prevention of stroke with ASS or clopidogrel showing the most consistent data. Due to a propor- tionately higher risk of bleeding complications, platelet inhibitors are not
recommended for primary stroke prevention. Carotid endarterectomy remains the gold standard for patients with symptomatic carotid stenosis
because of an increased procedural stroke risk with carotid stenting.
Surgery for patients with asymptomatic carotid artery stenosis should
be viewed critically with respect to an only marginal benefit and
improvement in medical therapies.
Patients with symptomatic intracranial stenosis or cryptogenic stroke
(and a patent foramen ovale) should receive medical treatment.
Masuhr F und Busch MA: Primär- und Sekundärprävention des Schlaganfalls. Internist 2012;53:1496-1504
New oral anticoagulants are slightly more effective than coumarin and significantly reduce the risk of intracranial hemorrhage. They offer the opportunity to bring more patients with atrial fibrillation at risk for stroke into anticoagulation - particularly those on ASS therapy (!). Background and aim of my question are to find out, why this remains obviously a problem in most European countries including Germany in spite of the warning of international guidelines, not to use ASS anymore in primary stroke prevention.
The new paper to discuss the problem of prevention
Article Hirninfarktprävention
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