Aspirin in ischemic cerebrovascular disease. How strong is the case for a different dosing regimen?

Stroke; a Journal of Cerebral Circulation
C Patrono, G J Roth

Abstract

A vast consensus exists in defining a narrow range of recommended daily doses of aspirin, ie, 75 to 160 mg, for the prevention of myocardial infarction, stroke, and vascular death in patients with different manifestations of coronary hearth disease. In contrast, for patients with cerebrovascular disease, a much larger degree of uncertainty still exists, with recommendations ranging from 30 to 1300 mg daily. The contention that higher doses of aspirin (650 to 1300 mg) are more effective than lower doses in stroke prevention is based on indirect and selective comparisons of different trial data, mini-meta-analyses, or subgroup analyses of individual trials. In the absence of definitive evidence from direct randomized comparisons of low-dose versus high-dose aspirin in trials of adequate size to detect a moderate difference between the two, the biological hypotheses that underpin the suggestion of greater efficacy of higher aspirin doses in cerebrovascular disease patients are reviewed and disputed. Practical implications of the use of higher doses of aspirin are also assessed on the basis of theoretical calculations of absolute benefits and risks. Until additional information from ongoing trials is available, good clinical practi...Continue Reading

References

Jun 1, 1975·Proceedings of the National Academy of Sciences of the United States of America·S OttolenghiC S Pitcher
Jul 13, 1978·The New England Journal of Medicine·UNKNOWN Canadian Cooperative Study Group
Aug 1, 1975·Proceedings of the National Academy of Sciences of the United States of America·G J RothP W Majerus
Jul 16, 1992·The New England Journal of Medicine·J E WillardL D Hillis
Dec 5, 1991·The American Journal of Cardiology·J L Anderson
Dec 1, 1991·Journal of Neurology, Neurosurgery, and Psychiatry·B FarrellC Warlow
Oct 31, 1991·The New England Journal of Medicine·UNKNOWN Dutch TIA Trial Study GroupAnet van Latum
Jul 20, 1989·The New England Journal of Medicine·UNKNOWN Steering Committee of the Physicians' Health Study Research Group
Oct 16, 1986·The New England Journal of Medicine·D J FitzgeraldG A FitzGerald
Jun 1, 1982·The Journal of Clinical Investigation·P PatrignaniC Patrono
Jan 26, 1995·The New England Journal of Medicine·H J BarnettH E Meldrum
May 5, 1994·The New England Journal of Medicine·C Patrono
Jan 1, 1992·Trends in Cardiovascular Medicine·C PatronoG Ciabattoni

❮ Previous
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Citations

Jun 10, 2003·Current Atherosclerosis Reports·Curtis Benesch
Mar 20, 2002·Current Neurology and Neuroscience Reports·Eugene D Kaplan, Ralph L Sacco
Aug 27, 2002·Current Treatment Options in Cardiovascular Medicine·Hans-Christoph Diener, Peter Ringleb
Aug 7, 2001·Current Treatment Options in Neurology·Hans-Christoph Diener, Peter Ringleb
Jul 21, 1998·European Journal of Pharmacology·Y YoshidaM Osame
Dec 3, 1999·Journal of the Neurological Sciences·A ChamorroA Ordinas
Sep 3, 1999·Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie·H C Diener
Sep 23, 2006·The Neurologist·Geysu KarlikayaHülya Tireli
Jun 18, 1999·Archives of Disease in Childhood·F J Kirkham
Jan 5, 2013·Circulation Research·Desmond J Fitzgerald, Garret A Fitzgerald
Aug 13, 2013·Stroke Research and Treatment·Philip B Gorelick, Muhammad U Farooq
Jul 1, 1997·Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine·T A Pearson, W Feinberg
Aug 9, 2006·Current Medical Research and Opinion·Matt Fisher, Volker Knappertz
Jun 11, 2005·Journal of Thrombosis and Haemostasis : JTH·H-C Diener
Aug 19, 2008·International Journal of Stroke : Official Journal of the International Stroke Society·Hans-Christoph Diener
Jun 7, 2005·Expert Opinion on Pharmacotherapy·Hans-Christoph DienerPierre Savi
May 12, 2004·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·David F Kong
May 18, 1999·The Medical Journal of Australia·R I Baker, G J Hankey

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