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Discontinuation of Aspirin Increases Risk of Stroke in Patients With Cardiovascular, Cerebrovascular Diseases: Presented at ESC By Chris Berrie BARCELONA, Spain -- May 30, 2010 -- Discontinuation of low-dose aspirin (ASA) therapy is associated with a significant increase in risk of ischaemic stroke and transient ischaemic attack (IS/TIA) in patients with a previous diagnosis of cardiovascular or cerebrovascular diseases, according to a study presented here at the 19th European Stroke Conference (ESC). "Treatment with low-dose aspirin is standard care for the secondary prevention of ischaemic cerebrovascular disease," said Lucia Cea Soriano, Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain, on May 27. However, in clinical trials, discontinuation rates of low-dose ASA have been reported of around 20%, while some hospital-based studies have seen indications of increased risks of cardiovascular events upon low-dose ASA discontinuation. The aim of this study was thus to evaluate the effect of low-dose ASA discontinuation on the risk of IS/TIA. The relevant study cohort was identified from The Health Improvement Network (THIN) UK primary care computerised database. A total of 39,512 patients (50-84 years) who had a first prescription for low-dose ASA (75-300 mg/d) for secondary prevention of cardiovascular events were included in the study. Patients were followed-up for a mean of 3 years to identify cases of IS/TIA, through which a total of 673 cases were identified. These were combined with controls with no reports of IS/TIA who were randomly selected from the study cohort (n = 5,000). The overall incidence of IS/TIA was 5.0 per 1,000 person-years, which was higher for women (5.5) than men (4.6). However, the incidence of IS/TIA was more common in the cases with a previous diagnosis of cerebrovascular disease (relative risk [RR], 2.79) or atrial fibrillation (RR, 1.71). Within the cases and controls, 10.0% and 7.5%, respectively, discontinued their low-dose ASA therapy 31 to 180 days before the index date. When compared with current users of low-dose ASA, these who discontinued treatment had an increased overall risk of IS/TIA (RR, 1.40). Soriano also noted that within these discontinuers, the risk of IS/TIA appeared not to be related to the low-dose ASA dose or treatment duration. Furthermore, there was a loss of significance for this risk of IS/TIA for longer low-dose ASA discontinuation periods (up to 1 year). Following the definition of this low-dose ASA discontinuation according to lack of efficacy, safety concerns, and use of over-the-counter ASA, the remaining and most common reason for discontinuation was patient nonadherence. Funding for this study was provided by AstraZeneca. [Presentation title: Increased Risk of Stroke After Discontinuation of Low-Dose Acetylsalicylic Acid Therapy: A UK Primary Care Study. Abstract 10] E-mail this page to a friend or colleague! To print, use this version