title: Ischemic stroke in patients receiving aspirin.
abstract: BACKGROUND
  The widespread use of aspirin-driven vascular prevention strategies does not impede the occurrence of first and recurrent ischemic strokes in numerous subjects. It is not clear what factors are associated with aspirin failure beyond the functional diagnosis of aspirin resistance in selected subjects. Current management guidelines provide little or no recommendations on the proper strategy for subjects who had a stroke while receiving aspirin. We assessed clinical features of subjects who had a first or recurrent stroke while taking aspirin.
  
  
  METHODS
  We studied demographic characteristics, vascular risk factors, stroke subtypes, and concomitant medication use in subjects with first or recurrent ischemic strokes. Patients receiving antiplatelet medications other than aspirin and/or oral anticoagulants were excluded from this analysis.
  
  
  RESULTS
  Seven hundred and nine patients with first (n = 552) or recurrent (n = 157) ischemic stroke were evaluated. Aspirin was being taken by 29% of first and 48% of recurrent stroke subjects. There was a higher prevalence of hypertension, hypercholesterolemia, and smoking in aspirin users with first and recurrent stroke (P < .05). Diabetes and coronary artery disease were more frequent in aspirin users with first ischemic strokes (P < .003), but not in those who had recurrent ischemic strokes. Aspirin users were more likely to be also receiving statins and antihypertensive drugs (P < .001).
  
  
  CONCLUSIONS
  Aspirin failure in ischemic stroke prevention may exceed functional resistance to aspirin and could be associated with a higher prevalence of lacunar stroke, comorbidities, and/or adverse interactions with other drugs. These patients may require a different approach regarding prevention strategies.
authors.affiliation: Institute for Neurological Research, FLENI, Buenos Aires, Argentina.
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Pujol Lereis
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ameriso
authors.forename: Guillermo P
authors.initials: GP
authors.lastname: Povedano
authors.forename: Sebastián F
authors.initials: SF
authors.lastname: Ameriso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001118:Argentina / Q000453:epidemiology; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000453:epidemiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D004347:Drug Interactions; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods*; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin