Antiplatelet therapy for acute ischaemic stroke.
BACKGROUND
In patients with acute ischaemic stroke, platelets become activated. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and reduce the risk of early recurrent ischaemic stroke. This might reduce the risk of early death and improve long-term outcome in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage.


OBJECTIVE
To assess the efficacy and safety of antiplatelet therapy in acute ischaemic stroke.


METHODS
We searched the Cochrane Stroke Group Trials Register (last searched June 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2007), MEDLINE (June 1998 to May 2007), and EMBASE (June 1998 to May 2007). In 1998, for a previous version of this review, we searched the register of the Antiplatelet Trialists' Collaboration, MedStrategy and contacted relevant drug companies.


METHODS
Randomised trials comparing antiplatelet therapy (started within 14 days of the stroke) with control in patients with definite or presumed ischaemic stroke.


METHODS
Two review authors independently applied the inclusion criteria and assessed trial quality, and for the included trials, extracted and cross-checked the data.


RESULTS
Twelve trials involving 43,041 participants were included. Two trials testing aspirin 160 mg to 300 mg once daily started within 48 hours of onset contributed 94% of the data. The maximum follow up was six months. With treatment, there was a significant decrease in death or dependency at the end of follow up (odds ratio 0.95, 95% confidence interval 0.91 to 0.99). For every 1000 patients treated with aspirin, 13 patients will avoid death or dependency (number needed to treat to benefit: 79). Antiplatelet therapy was associated with a small but definite excess of symptomatic intracranial haemorrhages, but this was more than offset by the reduction of recurrent ischaemic strokes and pulmonary embolus.


CONCLUSIONS
Antiplatelet therapy with aspirin 160 mg to 300 mg daily, given orally (or by nasogastric tube or per rectum in patients who cannot swallow), and started within 48 hours of onset of presumed ischaemic stroke reduces the risk of early recurrent ischaemic stroke without a major risk of early haemorrhagic complications and improves long-term outcome.
Sandercock
Peter A G
PA
Department of Clinical Neurosciences, University of Edinburgh, Neurosciences Trials Unit, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU. peter.sandercock@ed.ac.uk
Counsell
Carl
C
Gubitz
Gordon J
GJ
Tseng
Mei-Chiun
MC
D002545:Brain Ischemia / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control
D010975:Platelet Aggregation Inhibitors