stroke, aspirin to prevent stroke

People who experience a transient ischemic attack, also known as a TIA or a minor stroke, are at a significantly increased risk for another blood clot in the brain. In a TIA, the clot resolves on its own without causing lasting damage. But a persistent clot in the brain makes for an ischemic (pronounced iss-KEE-mik) stroke. The consequences can be devastating. As a result, doctors often prescribe anticlotting drugs such as rivaroxaban (Xarelto), clopidogrel (Plavix) or aspirin to prevent stroke.

How Effective Is Aspirin to Prevent Stroke?

Aspirin is an old drug. Although it keeps blood platelets from sticking together to form blood clots, it doesn’t get much respect. It is, however, a standard treatment to prevent a recurrent stroke. Researchers recently published the results of an international study comparing aspirin along with Plavix to just aspirin to prevent stroke (New England Journal of Medicine, May 16, 2018).

The scientists recruited 4,881 patients who had experienced a high-risk TIA or a minor stroke. They assigned these individuals randomly to take either a combination of clopidogrel, the generic name for Plavix, together with aspirin or aspirin alone.

The investigators stopped the study early, when only 84 percent of the expected volunteers were enrolled. A committee set up to monitor safety data found that the combination treatment significantly reduced the risk for a blood clot in the brain. Five percent of the people taking the combination treatment had a “major ischemic event” defined as a stroke, a heart attack or death from one of these. That compares well to 6.5 percent of the volunteers who took only aspirin.

Greater Risk of Bleeding:

The downside, however, was that the combination increased the risk for hemorrhage over 90 days more than aspirin alone. The percentages: 0.9 percent of those on clopidogrel and aspirin vs. 0.4 percent of those on nothing more than aspirin to prevent stroke. That comes out to more than twice the chance of a serious bleed. When doctors and patients decide whether to use combination therapy or rely on aspirin by itself, they will want to take these findings into account.

A different study published at the same time compared Xarelto with aspirin to prevent stroke. Although people taking Xarelto were just as likely as those taking aspirin to have a second stroke, they were about twice as likely to have a serious hemorrhage.

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  1. Marti A.

    I have been taking 81 mg. of aspirin daily after coming off drugs to treat a DVT a couple of years ago. My left arm is full of red blotches caused by the slightest contact with anything, even my purse straps. My doctor said to reduce the dose to every other day, and see if the condition improves.

  2. kassandra

    It’s interesting that they stopped the study early when it became obvious that aspirin is safer than Plavix. My guess is that the study was funded by the makers of Plavix, and that they didn’t want further proof that Plavix is less-safe than aspirin.

  3. Mike
    Maple Valley, WA

    Anyone concerned about blood clots should research nattokinase. This is an enzyme derived from a fermented soy cheese. It travels in the blood stream and devours a clot as it begins to form. It comes in 100mg capsules, has NO side effects. The safest dose is one capsule every four hours. It is the best way to prevent DVT on long airplane flights.

  4. Frank

    No mention of warfarin?

  5. Myrna
    BC, Canada

    I have a problem with my blood not clotting so am limiting my intake of curcumin to one capsule a week! I have considered taking aspirin as several of my female relatives have had strokes and one died of a brain aneurysm!
    I am concerned that it will complicate my bleeding issues! My ferritin levels are always at very very lowest end of the normal range (a vegetarian diet) so am encouraged by my doctor to take a iron supplement! I am a healthy 74 year old woman!
    Any observations on what I have written?

    Is it possible that I don’t need or should not

  6. Martha

    I haven’t had any TIAs or stroke of any kind. I have shown occasional short afib when I get my pacemaker checkups. My doctor wants me to take Eliquis and I refuse to take it. Two of my friends died from bleeding stokes and they were on blood thinners.
    My BP is well controlled and cholesteral is good. I don’t take statins either. I take turmeric with black pepper every day. I take occasional aspirin.
    79 female and feel fine

  7. Jackie
    Maitland, Fl.

    I take Xarelto because I have a fib and a family history of stoke. I don’t know if I will be able to continue this medication as I am having a lot pains in my arms and legs especially at night. I cannot take aspirin because I have tinnitus. Is there no natural way to thin blood which doesn’t have so many side effects? I am 76 and afraid of my situation.

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