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There are two major trials of aspirin in acute ischemic stroke.Taken together,CAST and the similarly large IST show reliably that aspirin started early in hospital produces a small but definite net benefit,with about 9 fewer deaths or nonfatal strokes per 1000 in the first few weeks and with 13 fewer dead or dependent per 1000 after some weeks or months of followup.newabs CVD249SD Neither heparin regimen offered any clinical advantage at 6 months.The results suggest that if heparin is given in routine clinical practice,the dose should not exceed 5000 units subcutaneously twice daily.For aspirin,the IST suggests a small but worthwhile improvement at 6 months.Taking the IST together with the comparably large Chinese Acute Stroke Trial,aspirin produces a small but real reduction of about 10 deaths or recurrent strokes per 1000 during the first few weeks.Both trials suggest that aspirin should be started as soon as possible after the onset of ischemic stroke;previous trials have already shown that continuation of low dose aspirin gives protection in the longer term. |
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