Clarifying Low-Dose Aspirin Guidelines for Stroke Patients

Experts from the Cedars-Sinai Comprehensive Stroke Center are urging stroke patients not to stop taking daily low-dose aspirin without consulting their doctors. Confusion over a recent U.S. Preventive Services Task Force recommendation has caused some patients with a history of stroke to abruptly stop the medication, putting their health at risk.

Aspirin is typically prescribed for patients who have experienced or are at increased risk for ischemic stroke, where a blood clot blocks or narrows an artery supplying blood to the brain. Almost 800,000 people in the U.S. have a stroke each year, and ischemic stroke is the most common type.

The task force recommended that patients who have never had a heart attack or stroke not begin a low-dose aspirin regimen because the very slight risk of internal bleeding caused by the aspirin outweighs its potential benefit in preventing a first heart attack or stroke for these patients.

The Cedars-Sinai Newsroom asked Shlee S. Song, MD, director of the Comprehensive Stroke Center, vice chair for Neurology System Integration and professor of Neurology at Cedars-Sinai, and Konrad H. Schlick, MD, assistant professor of Neurology and director of the Vascular Neurology Fellowship Program, to clarify aspirin recommendations for stroke patients and others.

Newsroom: Why are some patients confused by this new recommendation?
Konrad Schlick, MD: The recommendation applies only to patients who have never had a heart attack or stroke. It does not apply to people who have already had a stroke or heart attack, or are at increased risk for one, but some of these patients mistakenly think that it applies to them as well.

Newsroom: Have any of your patients stopped taking their aspirin because of this recommendation?
Shlee S. Song, MD: Yes, many. And it was alarming. Even before this recommendation was so well publicized, we had stroke patients who stopped their aspirin and later arrived in the Emergency Department with a new stroke. Media reports about the recommendation made some of our stroke patients feel that there was not a clear benefit for them. This isn’t true. If a patient’s doctor has recommended low-dose aspirin—or any preventive medication—the patient shouldn’t discontinue taking it without discussing it with their physician.

Newsroom: Why is low-dose aspirin often recommended for patients who have experienced a stroke?
Konrad H. Schlick, MD: There are two distinct kinds of stroke: the bleeding type and the clotting type. Patients who have had a clotting type of stroke benefit from taking a daily aspirin because it reduces the tendency of the platelets in the blood to clump together and form clots, and so it reduces the patient’s risk of another stroke.
Shlee S. Song, MD: This also applies to patients who haven’t had a stroke but have had a stent placed somewhere. Stopping their recommended aspirin combination therapy could cause a stent blockage for those patients.

Newsroom: How do we know that aspirin use is safe for these patients?
Konrad H. Schlick, MD: Very large studies of many patients who take aspirin for secondary stroke prevention have made it clear that the benefits of reducing risk of recurrent stroke significantly outweigh the small risk of an adverse event with aspirin.
Shlee S. Song, MD: We also discuss bleeding risks with our patients and review their health screening evaluations like their colonoscopy results, history of stomach ulcer, and other details before recommending low-dose aspirin. We only recommend aspirin if the benefits outweigh the risk for that patient.

Newsroom: Once low-dose aspirin is recommended for a patient, how long do they need to stay on it?
Shlee S. Song, MD: Sometimes our patients whose stroke happened six months or a year ago think that taking aspirin is no longer necessary, but that stroke history actually stays with you. So, unless your doctor says you no longer need to take it, that regimen still needs to continue at year two, year three and beyond.

Read more on the Cedars-Sinai Blog: Code Brain: After Stroke Care