Previous use of aspirin and baseline stroke severity: an analysis of 17,850 patients in the International Stroke Trial.
OBJECTIVE
Some studies suggest that taking aspirin regularly at the time of the onset of stroke reduces stroke severity. Other studies suggest the converse (ie, that previous aspirin therapy is associated with greater stroke severity). We sought to examine this question among the patients enrolled in the International Stroke Trial (IST).


METHODS
Analysis of the associations of reported use of aspirin in the 3 days before randomization in IST with baseline stroke severity (as assessed by stroke clinical syndrome, predicted outcome at 6 months, and observed outcome at 6 months). We adjusted analyses for confounding factors.


RESULTS
We excluded those patients who were first scanned after trial entry and were found to have an intracerebral hemorrhage as the cause of the stroke leading to randomization. We performed analyses for all treatment groups combined. For the 17,850 patients with ischemic stroke, data at baseline and follow-up were available for 100% and 99%, respectively. Among these patients, 3820 (21.4%) reported previous aspirin use. Previous aspirin use appeared, in univariate analyses, to be associated with greater baseline stroke severity, more severe stroke syndrome, and, in control subjects, worse observed outcome at 6 months. However, after adjustment, these associations were no longer significant.


CONCLUSIONS
In this large prospective and complete data set, we found no evidence of any association of previous aspirin use with baseline stroke severity. The analyses suggest that previously reported positive and negative associations may well have been attributable to the play of chance in small samples, confounding or other biases, rather than a biological effect of aspirin.
Ricci
Stefano
S
UOCD Neurologia e Ictus, USL 2, Centro di Salute, Via Cestellini, Perugia, Italy. istitaly@unipg.it
Lewis
Steff
S
Sandercock
Peter
P
D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000517:prevention & control*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011292:Premedication; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018401:Sample Size; D012494:Sampling Studies; D015983:Selection Bias; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin