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| |  Low Dose Aspirin At Least As Effective As High Doses In Preventing Stroke CHICAGO, IL -- January 30, 2001 -- Low doses of aspirin (80 to 325 mg) are at least as effective as higher doses (500 to 1,000 mg) in preventing stroke in patients with cerebrovascular disease, according to new guidelines released by the American College of Chest Physicians (ACCP). Entitled "The Sixth ACCP Consensus Conference on Antithrombotic Therapy," the guidelines represent expert consensus on various complications of atherosclerosis and related medical and surgical conditions. A range of experts participated in reviewing all significant studies on the prevention and treatment of thrombosis and developed recommendations on specific conditions and approaches. The report was issued as a special supplement to January’s issue of CHEST, ACCP’s peer-reviewed journal. There are nearly four million stroke survivors in the United States today. Of more than 730,000 who experience a stroke each year, five to 14 percent will have another stroke within one year. In addition, up to 35 percent of individuals who suffer a TIA (transient ischemic attack) will go on to have a full stroke, 12 percent within the first year after the event. Antiplatelet and anticoagulant therapy, combined with other medical management and lifestyle modifications, can significantly help to reduce the risk of a recurrent stroke. Authors of the stroke guidelines analyzed data from several major studies including the Swedish Aspirin Low-Dose Trial that showed a significant reduction in stroke risk using only 75 mg of aspirin. In fact, the benefit was greater than that of a study using similar patients who had a higher dosage. Another study-the Dutch TIA Study-compared two dosage regimens of aspirin (30 mg vs 273 mg) in over 3,000 patients who suffered TIAs or minor strokes. The findings showed the lower dose to be just as effective as the higher dose without as many bleeding events. Data from earlier studies, including the United Kingdom Transient Ischaemic Attack trial, added to the evidence that there are no important differences in daily doses of aspirin between 30 mg and 1,300 mg for preventing stroke and other vascular events. The guidelines’ authors also noted that since the previous consensus report of two years ago, other antiplatelet drugs have been found to be effective in preventing strokes and stroke deaths, including ticlopidine, clopidogrel, and dipyridamole (particularly when used in combination with aspirin). They recommended that patients with a (noncardioembolic) stroke or TIAs should receive an antiplatelet agent regularly to reduce the risk of recurrent stroke and other vascular events. The listed acceptable options for initial therapy are: 50 to 325 mg of aspirin; combination of 25 mg of aspirin and 200 mg of extended-release dipyridamole twice a day, or 75 mg of clopidogrel daily. For treatment of acute ischemic stroke within three hours of the onset of symptoms, the guidelines recommended the administration of intravenous (IV) recombinant tissue plasminogen activator (tPA) in a dose of 0.9 mg/kg with 10 percent of the dose given as an initial bolus (a large amount administered rapidly) and the remainder infused over 60 minutes for eligible patients. The guidelines also called for all men and women over the age of 50 with at least one risk factor for heart disease to consider taking an aspirin daily as a means of helping to prevent a heart attack. These risk factors include high blood pressure, high blood cholesterol, smoking, obesity, diabetes, lack of exercise, and family history. Other topics addressed in the guidelines include: Antithrombotic Agents in Coronary Artery Disease; Antithrombotic and Thrombolytic Therapy for Ischemic Stroke; Prevention of and Therapy for Venous Thromboembolism; Antithrombotic Therapy in Children; Use of Antithrombotic Agents During Pregnancy; IV Thrombolysis in Acute Myocardial Infarction; Antithrombotic Therapy in Valvular Heart Disease; Antithrombotic Therapy in Atrial Fibrillation; Hemorrhagic Complications of Anticoagulant Treatment; Antithrombotic Therapy in Peripheral Arterial Occlusive Disease; Antithrombotic Therapy in Patients With Saphenous Vein and Internal Mammary Artery Bypass Grafts; Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention; Platelet-Active Drugs; Heparin and Low-Molecular-Weight Heparin; New Anticoagulant Drugs. and Managing Oral Anticoagulant Therapy.
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