| Stroke survivors who take aspirin and have | | | | stroke recurrence in some, but not all, stroke |
| elevated blood levels of cholesterol and other lipids | | | | survivors. |
| may need to take higher doses of aspirin to | | | | "It provides another piece of the puzzle as to |
| prevent a second brain attack, a new study finds. | | | | why some people fail with aspirin," says Helgason. |
| Vadim Karepov, M.D., Ph.D., and his colleagues at | | | | "It suggests that some are not taking the right |
| the Tel Aviv Medical Center in Israel, examined | | | | doses and that there might be a particular dose |
| the patient profiles of 3,140 consecutive stroke | | | | for a particular person." |
| patients, 2,239 of whom had a first ischemic | | | | Karepov is one of a team of researchers involved |
| stroke, and 901 of whom had experienced a | | | | in the Tel Aviv Stroke Study, a project focusing |
| second ischemic stroke. They found that aspirin | | | | on stroke prevention |
| failed to act in 126 of the 2,239 with a first | | | | In the study Karepov explored causes of aspirin |
| stroke and 157 of the 901 with a second stroke. | | | | failure, including age, ischemic heart disease, |
| Aspirin doses in these patients ranged from 100 | | | | cholesterol and lipid levels and inadequate aspirin |
| to 1,000 milligrams (mg) daily. | | | | dose. The 3,140 men and women who |
| An ischemic stroke is one caused by a reduction | | | | participated in the trial were grouped according to |
| or cessation of blood flow, usually resulting from a | | | | whether they had had one or more strokes and |
| clot that plugs up an artery that feeds blood to | | | | if they had taken aspirin regularly as a preventive |
| the brain. | | | | treatment |
| The researchers found that individuals who have | | | | Hyperlipidemia and aspirin dose were the only |
| hyperlipidemia (elevated cholesterol and other | | | | striking links to aspirin failure. Among patients who |
| lipids) were most prone to aspirin failure and might | | | | had suffered a single stroke, hyperlipidemia was |
| benefit from higher doses than typically used | | | | associated with aspirin failure in 23 percent of |
| (aspirin doses usually range from 125 - 1,000 mg | | | | cases. Hyperlipidemia was present in only 7.8 |
| daily). | | | | percent of patients who responded to aspirin. |
| Karepov presented these results today at the | | | | Similar trends were found among patients with |
| AHA's 21st International Joint Conference on | | | | recurrent strokes. Hyperlipidemia was observed in |
| Stroke and Cerebral Circulation. | | | | 14 percent of the aspirin-failed group versus 6.4 |
| "Our results show a possible way of preventing a | | | | percent of those whom aspirin did not fail. |
| second stroke in these patients who will require | | | | "We have seen that aspirin prevents mortality |
| higher doses or other aggressive therapy," says | | | | and severity of recurrent strokes, but it is less |
| Karepov, noting that the effectiveness of aspirin | | | | effective in patients with such ischemic heart |
| increased with doses of 350 mg/day or more. | | | | disease risk factors as hyperlipidemia. These |
| Aggressive therapy in such cases could include | | | | patients need more aggressive therapy or bigger |
| such actions as: higher aspirin doses; use of the | | | | doses," concludes Karepov. |
| drug Ticlid (which keeps platelets -- blood- clotting | | | | Although aspirin has been used for about 15 years |
| components -- from sticking together); treatment | | | | as preventive therapy against second strokes, it |
| with anticoagulants; and combination drug therapy, | | | | averts only about 25 percent of recurrent |
| Karepov says. | | | | strokes. Aspirin also has not been shown |
| Cathy Helgason, M.D., professor of neurology at | | | | effective against first strokes, according to |
| the University of Illinois College of Medicine in | | | | Karepov. |
| Chicago, comments that the Tel Aviv study's | | | | Stroke is the third leading cause of death and the |
| results were consistent with other research | | | | leading cause of serious disability in the United |
| showing that aspirin is effective in preventing | | | | States. |