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The urgent use of aspirin after Transient Ischaemic Attack and stroke

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    Lucy Crawford considers recent research on the benefits of taking aspirin early following a Transient Ischaemic Attack (TIA) in relation to preventing major stroke and reducing the effects of stroke.

    By Lucy Crawford

I have been reading with interest the recent research carried out by researchers at Oxford University which has suggested that the urgent use of treatments such as aspirin can reduce the risk of recurrent stroke by up to 80%. Unfortunately, until now, very little research had been done proving such a link. The EXPRESS study (Early use of Existing Preventive Strategies for Stroke) sets about demonstrating this link and I hope will bring about a change in hospitals and healthcare systems when it comes to front line treatment.

Types of Stroke

 The Stroke Association defines a stroke as:

“A stroke is a brain attack. It happens when the blood supply to part of your brain is cut off. Blood carries essential nutrients and oxygen to your brain. Without blood your brain cells can be damaged or die.  This damage can have different effects, depending on where it happens in your brain. A stroke can affect the way your body works as well as how you think, feel and communicate

 There are two main types of stroke:

  • ischaemic (caused by a blood clot); and
  • haemorrhagic (caused by ruptured blood vessels forming a bleed in the brain).

A person can also suffer a TIA (also known as a mini stroke) and is caused by a temporary blood clot after which symptoms subside.

 The use of Aspirin in Stroke

Aspirin is most commonly associated with pain relief. However, in low doses (usually around 75mg), it has an antiplatelet effect.

When there is a damaged blood vessel, a chemical is produced to attract the platelets in blood to stick together and form a clot to prevent further bleeding. An antiplatelet medicine reduces the ability for the blood to stick together and form a clot.  This in turns helps prevent a stroke.

Aspirin is primarily used for the treatment of TIA and ischaemic stroke.

Findings of recent research

Research suggests the risk of major stroke is extremely high after a TIA or minor stroke. Treatment to try and prevent such major reoccurrences would be extremely important in the future management of stroke patients.

Pooling data from 12 trials of Aspirin (15,778 participants) a recent analysis has found that when looking at the risk of recurrence for the first 1-2 weeks following a TIA, the immediate use of aspirin reduced the risk by approximately 80%.   Not only this but the severity of symptoms in recurrence was dramatically reduced.

These results are very encouraging as the likelihood of experiencing life changing injuries is clearly much reduced which is very positive for patients.

Raising awareness amongst patients and doctors

The symptoms of TIA may only last for a few minutes or hours and often people recover without seeking medical assistance or delay seeing a doctor for a few days. Raising awareness of the importance of seeking medical advice early and encouraging people to take aspirin if they think they have had a TIA could help address this and may prevent the severity and reoccurrence of a major life changing stroke.

This research has potential wide-reaching implications for the expected medical management of TIAs and suspected stroke and the researchers involved in the recent study have called for all medical services, including first line services such as paramedics and the NHS 111 helpline, to recommend Aspirin to patients as early as possible.

NHS England are considering the results of the research and whether there need to be changes made to national guidelines for the management of TIAs and suspected strokes and I will be following developments in this area with interest.

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