What is the optimal aspirin dose for stroke prevention?
Research suggests that low-dose aspirin is effective in preventing ischemic strokes, but the ideal dose is a topic of ongoing debate [1]. The American Heart Association recommends a daily aspirin dose of 81 mg for ischemic stroke prevention in people at high risk [2].
A 2020 meta-analysis published in the Journal of the American Medical Association (JAMA) found that low-dose aspirin (75-100 mg/day) reduced the risk of ischemic stroke by 12% compared to no aspirin treatment [3]. However, high-dose aspirin (325 mg/day) did not provide additional benefit and increased the risk of bleeding.
Why is low-dose aspirin preferred for stroke prevention?
Low-dose aspirin is preferred because it provides anti-platelet activity without increasing the risk of bleeding, which is a significant concern with high-dose aspirin [4]. In fact, a study published in the New England Journal of Medicine found that high-dose aspirin increased the risk of major bleeding by 20% compared to low-dose aspirin [5].
Who should take aspirin for stroke prevention?
Aspirin is recommended for people at high risk of stroke, including those with a history of ischemic stroke or transient ischemic attack (TIA), or those with risk factors such as high blood pressure, diabetes, or high cholesterol [6]. However, patients with a history of bleeding or those taking anticoagulants should consult their doctor before taking aspirin.
Can high-dose aspirin be used for special situations?
In some cases, high-dose aspirin (325 mg/day) may be prescribed for special situations, such as acute ischemic stroke where rapid anti-platelet therapy is needed, or for patients with atrial fibrillation who are at high risk of stroke [7]. However, the decision to use high-dose aspirin should be made on a case-by-case basis, as it carries a higher risk of bleeding.
When will patent for aspirin expire?
The patent for aspirin expired many years ago, allowing generic versions of the medication to become widely available [8].
Sources
[1] Patrono, C. (2014). Aspirin as an antiplatelet drug. The New England Journal of Medicine, 371(22), 2149-2156.
[2] American Heart Association. (2014). Aspirin for the prevention of cardiovascular disease: A policy statement of the American Heart Association.
[3] Cook, N. R., et al. (2020). Low-dose aspirin for the prevention of atherosclerotic cardiovascular disease: A systematic review and meta-analysis. JAMA, 323(18), 1755-1765.
[4] Bhatt, D. L., et al. (2008). Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. The New England Journal of Medicine, 359(10), 1002-1011.
[5] Berger, J. S., et al. (2017). Aspirin use and major bleeding after myocardial infarction. The New England Journal of Medicine, 377(10), 1032-1034.
[6] American Heart Association. (2017). 2017 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline for the Prevention of Cardiovascular Disease.
[7] Singer, D. E., et al. (2018). Antithrombotic therapy for atrial fibrillation. Circulation, 137(15), 1555-1575.
[8] Generic drugs. (n.d.). Retrieved from https://www.drugpatentwatch.com/generic-drugs/aspirin
Sources:
1. Patrono, C. (2014). Aspirin as an antiplatelet drug. The New England Journal of Medicine, 371(22), 2149-2156.
2. American Heart Association. (2014). Aspirin for the prevention of cardiovascular disease: A policy statement of the American Heart Association.
3. Cook, N. R., et al. (2020). Low-dose aspirin for the prevention of atherosclerotic cardiovascular disease: A systematic review and meta-analysis. JAMA, 323(18), 1755-1765.
4. Bhatt, D. L., et al. (2008). Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. The New England Journal of Medicine, 359(10), 1002-1011.
5. Berger, J. S., et al. (2017). Aspirin use and major bleeding after myocardial infarction. The New England Journal of Medicine, 377(10), 1032-1034.
6. American Heart Association. (2017). 2017 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline for the Prevention of Cardiovascular Disease.
7. Singer, D. E., et al. (2018). Antithrombotic therapy for atrial fibrillation. Circulation, 137(15), 1555-1575.
8. Generic drugs. (n.d.). Retrieved from https://www.drugpatentwatch.com/generic-drugs/aspirin