bleeding in the brain, aspirin vs Activase

Alteplase, known under its brand name as Activase, is a clot buster. That means it is injected in the early treatment of stroke in an attempt to reduce damage to the brain. Might aspirin also be helpful? A clinical trial tested aspirin vs Activase head to head.

Aspirin vs Activase:

A new study published in JAMA compared Activase to aspirin in people experiencing mild strokes (Khatri et al, JAMA, July 10, 2018). Activase was injected at its standard dose of 0.9 mg/kg body weight. Aspirin was given as a standard 325 mg tablet. Surprisingly, there was no difference in benefit between the two in terms of favorable functional outcome.

Aspirin vs Activase did show a difference in side effects, however. Those on Activase were twice as likely to suffer a serious adverse event. In addition, five of the patients treated with alteplase experienced bleeding in the brain, compared to none of those on aspirin.

Why Can’t We Generalize These Results?

This is not the first study to suggest that aspirin may have value in treating stroke. Be wary of generalizing these findings, however. For one thing, these patients had only minor neurological problems apparent when they showed up for treatment. It is possible that people with more severe stroke damage would respond differently to aspirin vs Activase.

Moreover, this study was stopped early because the researchers had so much trouble recruiting patients to it. Perhaps the results would have been different if the original 948 patients had been tested as planned. Instead, the trial ended up with only 313 participants.

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  1. Steven
    Reply

    We need more studies like this. How about streptokinase? Would that deserve a new look? Could that be safe for select patients with acute stroke?

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