Deans' stroke musings: Aspirin for Primary Stroke Prevention; Evidence for a Differential Effect in Men and Women

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, June 23, 2022

Aspirin for Primary Stroke Prevention; Evidence for a Differential Effect in Men and Women

This is what is so bad about aspirin research. No research to specifically identify which persons that might have bleeding issues from aspirin.

Aspirin for Primary Stroke Prevention; Evidence for a Differential Effect in Men and Women

Zuzana Gdovinova¹^*,

Christine Kremer²,

Svetlana Lorenzano³,

Jesse Dawson⁴,

Avtar Lal⁵ and

Valeria Caso⁶

¹Neurology Department, Faculty of Medicine P.J. Safarik University Košice, L. Pasteur University Hospital, Košice, Slovakia
²Neurology Department, Skåne University Hospital, Department of Clinical Sciences Lund University, Malmö, Sweden
³Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
⁴College of Medical, Veterinary & Life Sciences, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
⁵European Stroke Organisation (ESO), Basel, Switzerland
⁶Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy

Background: The use of aspirin for primary prevention of cardiovascular events in men and women remains controversial. Our study aimed to investigate the role of aspirin in primary stroke prevention in men and women and the effect of aspirin on risk of ischemic stroke in patients with covert cerebral small vessel disease (ccSVD).

Methods: We performed systematic searches of the PubMed, and Cochrane Library databases, covering the period from the inception of each database to May 2021. The incidence of any ischemic stroke (IS) or hemorrhagic stroke (HS) was the main outcome. The incidence of stroke overall, both ischemic (IS) and hemorrhagic (HS), was the main outcome.

Results: From 531 abstracts, 11 randomized control trials which assessed primary prevention of cardiovascular events in men and women were included. Only one study assessed the risk of aspirin in people with ccSVD. In women, there was significant decrease in the risk of stroke (OR 0.85 [95% CI 0.73, 0.99], p = 0.03) and IS (OR 0.76 [0.63, 0.93], p = 0.008) with aspirin compared to placebo while no increase in the risk of HS was found (OR 1.78 [0.61, 5.19], p = 0.29). In men, aspirin did not affect the risk of stroke (OR 1.13 [0.97, 1.31], p = 0.12) and IS (OR 0.94 [0.67, 1.32], p = 0.72) but increased the risk of HS with borderline statistical significance (OR 1.99 [0.99, 4.03], p = 0.05) compared to placebo. Aspirin significantly increased major bleedings in both sexes (p < 0.05). We found no evidence to support the use of aspirin in patients with ccSVD.

Conclusion: Our meta-analysis suggests aspirin is effective in primary prevention of stroke and IS in women with no clear increased risk of HS. However, it was associated with an overall increased risk of bleeding. Aspirin is not recommended in ccSVD.

Introduction

The use of aspirin for the primary prevention of cardiovascular events in men and women remains controversial (1–7). The antithrombotic effect of aspirin is primarily related to the irreversible inhibition of the enzyme cyclooxygenase in platelets resulting in a decreased production of prostaglandins and thromboxane A2. Furthermore, aspirin reduces inflammation by forming nitric oxide radicals and protects endothelial cells from oxidative stress. Sex hormones are known to have differential effects on platelet function, with testosterone promoting platelet activity and estrogen inhibiting (8–10).

Based on these premises, our study aimed to investigate the role of aspirin in primary prevention in men and women. In addition, because the risk benefit ratio of antiplatelets may differ in people with cerebral small vessel disease, we also explored the effect of aspirin on risk of stroke risk in people with covert cerebral small vessel disease (ccSVD). Covert small vessel disease was defined as: Cerebral small vessel disease (SVD) with the presence of brain lesions found on CT or MR brain imaging or pathology examination, thought to have resulted from disease of the small blood vessels that perforate into the brain, primarily affecting the white matter and deep gray matter. The full spectrum includes covert cerebral SVD (ccSVD) detected incidentally on neuroimaging, and SVD-related clinical presentation with stroke, cognitive decline or dementia, mood or physical dysfunction (11).

We performed systematic searches of the PubMed, and Cochrane Library databases, covering the period from the inception of each database to May 2021; the incidence of stroke, both ischemic (IS) and hemorrhagic (HS), was the main outcome.