Article Commentary: “Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure”
Meghana Srinivas, MD
Lusk JB, Xu H, Peterson ED, Bhatt DL, Fonarow GC, Smith EE, Matsouaka R, Schwamm LH, Xian Y. Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure. Stroke. 2021;52:e777–e781.
When aspirin fails, what’s next? The use of aspirin for cardiovascular disease dates back to the 1950s to 1960s. It is only until very recently that studies have shown its lack of benefit in primary prevention of cardio and cerebrovascular diseases. In the United States, more than 40% of adults over the age of 70 years take aspirin for primary prevention of cardiovascular diseases, and more than 70% of patients of any age with a history of cardiovascular disease take daily aspirin. What’s next if patients who are taking aspirin for stroke prevention experience an ischemic stroke?
What can be tried? Increasing the dose of aspirin, adding a second drug, or switching to an alternate antiplatelet agent are often considered, but there is no evidence of superiority of one over the other. This study by Jay B. Lusk et al. used data from the American Heart Association Get with the Guidelines (GWTG) Stroke Registry to study the prevalence of aspirin failure in older patients who present with acute ischemic stroke and describe their discharge prescription pattern of antithrombotic therapy for secondary prevention of stroke.