Antiplatelet therapy for acute ischaemic stroke

Peter A G Sandercock, Carl Edward Counsell, Gordon J Gubitz, Mei-Chiun Tseng

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

BACKGROUND: In patients with acute ischaemic stroke, platelets become activated. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and reduce the risk of early recurrent ischaemic stroke. This might reduce the risk of early death and improve long-term outcome in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage. OBJECTIVES: To assess the efficacy and safety of antiplatelet therapy in acute ischaemic stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched June 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2007), MEDLINE (June 1998 to May 2007), and EMBASE (June 1998 to May 2007). In 1998, for a previous version of this review, we searched the register of the Antiplatelet Trialists' Collaboration, MedStrategy and contacted relevant drug companies. SELECTION CRITERIA: Randomised trials comparing antiplatelet therapy (started within 14 days of the stroke) with control in patients with definite or presumed ischaemic stroke. DATA COLLECTION AND ANALYSIS: Two review authors independently applied the inclusion criteria and assessed trial quality, and for the included trials, extracted and cross-checked the data. MAIN RESULTS: Twelve trials involving 43,041 participants were included. Two trials testing aspirin 160 mg to 300 mg once daily started within 48 hours of onset contributed 94% 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 (odds ratio 0.95, 95% confidence interval 0.91 to 0.99). For every 1000 patients treated with aspirin, 13 patients will avoid death or dependency (number needed to treat to benefit: 79). Antiplatelet therapy was associated with a small but definite excess of symptomatic intracranial haemorrhages, but this was more than offset by the reduction of recurrent ischaemic strokes and pulmonary embolus. AUTHORS' CONCLUSIONS: Antiplatelet therapy with aspirin 160 mg to 300 mg daily, given orally (or by nasogastric tube or per rectum in patients who cannot swallow), and started within 48 hours of onset of presumed ischaemic stroke reduces the risk of early recurrent ischaemic stroke without a major risk of early haemorrhagic complications and improves long-term outcome.
Original languageEnglish
Article numberCD000029
JournalCochrane Database of Systematic Reviews
Issue number3
DOIs
Publication statusPublished - 2008

Fingerprint

Stroke
Aspirin
Therapeutics
Intracranial Hemorrhages
Numbers Needed To Treat
Deglutition
Embolism
Brain Ischemia
Rectum
MEDLINE
Libraries
Survivors
Blood Platelets
Odds Ratio
Confidence Intervals
Safety
Lung
Pharmaceutical Preparations

Keywords

  • Brain Ischemia
  • Humans
  • Platelet Aggregation Inhibitors
  • Randomized Controlled Trials as Topic
  • Risk
  • Stroke

Cite this

Antiplatelet therapy for acute ischaemic stroke. / Sandercock, Peter A G; Counsell, Carl Edward; Gubitz, Gordon J; Tseng, Mei-Chiun.

In: Cochrane Database of Systematic Reviews, No. 3, CD000029, 2008.

Research output: Contribution to journalArticle

Sandercock, Peter A G ; Counsell, Carl Edward ; Gubitz, Gordon J ; Tseng, Mei-Chiun. / Antiplatelet therapy for acute ischaemic stroke. In: Cochrane Database of Systematic Reviews. 2008 ; No. 3.
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N2 - BACKGROUND: In patients with acute ischaemic stroke, platelets become activated. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and reduce the risk of early recurrent ischaemic stroke. This might reduce the risk of early death and improve long-term outcome in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage. OBJECTIVES: To assess the efficacy and safety of antiplatelet therapy in acute ischaemic stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched June 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2007), MEDLINE (June 1998 to May 2007), and EMBASE (June 1998 to May 2007). In 1998, for a previous version of this review, we searched the register of the Antiplatelet Trialists' Collaboration, MedStrategy and contacted relevant drug companies. SELECTION CRITERIA: Randomised trials comparing antiplatelet therapy (started within 14 days of the stroke) with control in patients with definite or presumed ischaemic stroke. DATA COLLECTION AND ANALYSIS: Two review authors independently applied the inclusion criteria and assessed trial quality, and for the included trials, extracted and cross-checked the data. MAIN RESULTS: Twelve trials involving 43,041 participants were included. Two trials testing aspirin 160 mg to 300 mg once daily started within 48 hours of onset contributed 94% 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 (odds ratio 0.95, 95% confidence interval 0.91 to 0.99). For every 1000 patients treated with aspirin, 13 patients will avoid death or dependency (number needed to treat to benefit: 79). Antiplatelet therapy was associated with a small but definite excess of symptomatic intracranial haemorrhages, but this was more than offset by the reduction of recurrent ischaemic strokes and pulmonary embolus. AUTHORS' CONCLUSIONS: Antiplatelet therapy with aspirin 160 mg to 300 mg daily, given orally (or by nasogastric tube or per rectum in patients who cannot swallow), and started within 48 hours of onset of presumed ischaemic stroke reduces the risk of early recurrent ischaemic stroke without a major risk of early haemorrhagic complications and improves long-term outcome.

AB - BACKGROUND: In patients with acute ischaemic stroke, platelets become activated. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and reduce the risk of early recurrent ischaemic stroke. This might reduce the risk of early death and improve long-term outcome in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage. OBJECTIVES: To assess the efficacy and safety of antiplatelet therapy in acute ischaemic stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched June 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2007), MEDLINE (June 1998 to May 2007), and EMBASE (June 1998 to May 2007). In 1998, for a previous version of this review, we searched the register of the Antiplatelet Trialists' Collaboration, MedStrategy and contacted relevant drug companies. SELECTION CRITERIA: Randomised trials comparing antiplatelet therapy (started within 14 days of the stroke) with control in patients with definite or presumed ischaemic stroke. DATA COLLECTION AND ANALYSIS: Two review authors independently applied the inclusion criteria and assessed trial quality, and for the included trials, extracted and cross-checked the data. MAIN RESULTS: Twelve trials involving 43,041 participants were included. Two trials testing aspirin 160 mg to 300 mg once daily started within 48 hours of onset contributed 94% 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 (odds ratio 0.95, 95% confidence interval 0.91 to 0.99). For every 1000 patients treated with aspirin, 13 patients will avoid death or dependency (number needed to treat to benefit: 79). Antiplatelet therapy was associated with a small but definite excess of symptomatic intracranial haemorrhages, but this was more than offset by the reduction of recurrent ischaemic strokes and pulmonary embolus. AUTHORS' CONCLUSIONS: Antiplatelet therapy with aspirin 160 mg to 300 mg daily, given orally (or by nasogastric tube or per rectum in patients who cannot swallow), and started within 48 hours of onset of presumed ischaemic stroke reduces the risk of early recurrent ischaemic stroke without a major risk of early haemorrhagic complications and improves long-term outcome.

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