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


RESULTS
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.


CONCLUSIONS
Until additional information from ongoing trials is available, good clinical practice should dictate the use of the lowest dose of aspirin shown effective in the prevention of stroke and death in patients with ischemic cerebrovascular disease, ie, 75 mg daily.
Patrono
C
C
Department of Pharmacology, University of Chieti, "G. D'Annunzio" School of Medicine, Italy.
Roth
G J
GJ
D001241:Aspirin / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000517:prevention & control*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D002561:Cerebrovascular Disorders / Q000517:prevention & control*; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013923:Thromboembolism / Q000188:drug therapy
D001241:Aspirin