The findings of this study indicate that the protective effect of acetylsalicylic acid in the secondary prevention of atherothrombotic complications after a stroke is highest in the early stages and that its protective effect in the longer term has been overestimated. The opposite is true for dipyridamol. This implies that immediate use of acetylsalicylic acid when early symptoms suggestive of stroke appear might be recommended. If a GP is called in immediately, he or she could prescribe this drug regardless of the further management. The use of acetylsalicylic acid is no contraindication for thrombolysis or thrombectomy. The potential risk of using acetylsalicylic acid before a cerebral haemorrhage has been excluded (that is, before a brain scan has been made) is low.
- International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet; 349: 1569–1581.
- CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomised placebo-controlled trial of early aspirin use in 20 000 patients with acute ischaemic stroke. Lancet; 349: 1641–1649.
- Chen ZM, et al. and IST collaborative groups. Indications for early aspirin use in acute ischemic stroke: A combined analysis of 40 000 randomized patients from the Chinese Acute Stroke Trial and the International Stroke Trial. Stroke; 31: 1240–1249.
- Rothwell PM, et al, for the Early use of Existing Preventive Strategies for Stroke (EXPRESS) Study. Major reduction in risk of early recurrent stroke by urgent treatment of TIA and minor stroke: EXPRESS Study. Lancet; 370:1432–1442.
- Luengo-Fernandez R, et al. Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): a prospective population-based sequential comparison. Lancet Neurol 2009; 8: 235–243.
- Rothwell PM, et al. Effects of aspirin on risk and severity of early recurrent stroke after transient ischemic attack and ischemic stroke: time-course analysis of randomised trials. Lancet 2016; 388: 365-375.
- Hankey GJ. The benefits of aspirin in early secondary stroke prevention. Lancet 2016; 388: 312-314.
*The literature refers to the Dutch text