Aspirin paper on primary prevention of stroke

Seniors who took low-dose aspirin daily for primary prevention had no reduction in the risk for first strokes in a large randomized trial that followed them for about 5 years (Daily Aspirin Challenged in Primary Stroke Prevention: ASPREE).

But those who took aspirin at 100 mg/d, compared with placebo, did show a significant 38% jump in risk for intracranial (IC) bleeding. Rates for ischemic stroke and for hemorrhagic stroke were similar between the aspirin and control groups.

The excess IC bleeding events included hemorrhagic stroke but also dural and subdural bleeds characteristic of traumatic head injury, such as from falls, researchers say, based on their secondary analysis of the ASPREE trial. The findings applied regardless of age, sex, or cardiovascular (CV) risk factors.

This study, as much as any other, has clouded aspirin's shine as a protectant against CV events in people without a history of stroke or clinical heart disease.

The trial, conducted in Australia and the United States, had entered 19,114 people from the community who were aged 70 years or older or at least 65 for participants in the US identifying as Black or Hispanic.