Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke.
BACKGROUND
Aspirin, or acetylsalicylic acid, is widely used to prevent ischemic vascular disease. Clinical and experimental data suggest that a rebound effect occurs 4 or fewer weeks after interruption of aspirin therapy.


OBJECTIVE
To study the discontinuation of aspirin therapy as a risk factor for ischemic stroke (IS).


METHODS
Case-control study.


METHODS
Stroke unit.


METHODS
Three hundred nine patients with IS or transient ischemic attack undergoing long-term aspirin treatment before their index event and 309 age-, sex-, and antiplatelet therapy-matched controls who had not had an IS in the previous 6 months.


METHODS
We compared the frequency of aspirin therapy discontinuation during the 4 weeks before an ischemic cerebral event in patients and the 4 weeks before interview in controls.


RESULTS
The 2 groups had a similar frequency of risk factors, except for coronary heart disease, which was more frequent in patients (36% vs 18%; P < .001). Aspirin use had been discontinued in 13 patients and 4 controls. Aspirin interruption yielded an odds ratio for IS/transient ischemic attack of 3.4 (95% confidence interval, 1.08-10.63; P < .005) after adjustment in a multivariable model.


CONCLUSIONS
These results highlight the importance of aspirin therapy compliance and give an estimate of the risk associated with the discontinuation of aspirin therapy in patients at risk for IS, particularly those with coronary heart disease.
Maulaz
Alexandre Balzano
AB
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Bezerra
Daniel C
DC
Michel
Patrik
P
Bogousslavsky
Julien
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects*; D002545:Brain Ischemia / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin