[From heart to brain and from brain to heart: impact of an anticoagulant treatment with aspirin in secondary prevention].
Aspirin given as a platelet antiaggregant has been shown to be effective for secondary prevention both in cardiology (myocardial infarction, uncontrolled angina pectoris, coronary bypass, etc.) and in neurology (after a cerebral vascular event or an episode of temporary ischaemia). For example, the risk of non-fatal recurrence is reduced by 31% after myocardial infarction and by 22% after cerebral vascular events. In the large scale trials which led to these findings, patients were usually included on the basis of one type of illness, heart disease of neurological disorder. However, these studies have also revealed a cross-over effect. For example a 35% reduction in non-fatal myocardial infarction after secondary preventive treatment for cerebral vascular events and a 42% reduction in cerebral vascular events after secondary preventive treatment for myocardial infarction. Such arguments suggest the importance of evaluating the dual brain/heart and heart/brain impact of secondary prevention. In addition, aspirin has been shown to be effective in certain forms of non-valvular atrial fibrillation and in vascular dementia. Recommended doses vary between 160 and 300 mg/day. Secondary cardiologic prevention with such doses has a favourable effect both on the cardiologic indications after infarction or poorly controlled angina pectoris and has an additional impact on primary prevention of neurological events. The Scientific Committee of the American Heart Association recommends the dose of 160 mg/day after myocardial infarction. For secondary neurological indications, recent studies demonstrate that the dose of 300 mg/day is as effective as higher doses which are less well tolerated and haematologists have underscored that doses below 160 mg/day would not have a sufficient anti-thrombotic effect. The recommended doses for neurological indications would thus be within this range. It is reasonable to expect a dual impact of secondary prevention with doses near 300 mg/day.
Chollet
F
F
Département de Neurologie et INSERM U 230, Centre hospitalier Purpan, Toulouse.
D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000517:prevention & control*; D015140:Dementia, Vascular / Q000150:complications / Q000517:prevention & control; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000517:prevention & control*; D009203:Myocardial Infarction / Q000150:complications / Q000517:prevention & control*
D000925:Anticoagulants; D001241:Aspirin
Du coeur au cerveau et du cerveau au coeur: impact d'un traitement anti-agrégant par l'aspirine en prévention secondaire.