Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials.

@article{He1998AspirinAR,
  title={Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials.},
  author={J. He and Paul K. Whelton and Brian Vu and Michael John Klag},
  journal={JAMA},
  year={1998},
  volume={280 22},
  pages={
          1930-5
        }
}
CONTEXT Aspirin has been widely used to prevent myocardial infarction and ischemic stroke but some studies have suggested it increases risk of hemorrhagic stroke. [] Key MethodDATA SOURCES Studies were retrieved using MEDLINE (search terms, aspirin, cerebrovascular disorders, and stroke), bibliographies of the articles retrieved, and the authors' reference files. STUDY SELECTION
Aspirin for the primary prevention of stroke and other major vascular events: meta-analysis and hypotheses.
TLDR
It is hypothesized that the effect of aspirin therapy on stroke for persons with major risk factors for vascular disease may be intermediate between a substantial decrease for those with manifest vascular disease and a possible small increase for healthy persons due to accentuated intracranial hemorrhage.
Risk of hemorrhagic stroke from aspirin use: Does risk outweigh the benefit?
TLDR
Aspirin is now being used for primary and secondary prevention of cardiovascular disease in the general population and should be used with caution in individuals, who are at high risk of hemorrhagic stroke, e.g., hypertensive patients with a low level of serum.
Risk of Hemorrhagic Stroke With Aspirin Use: An Update
TLDR
The evidence from primary prevention of MI studies, including that from the recent Women’s Health Study evaluation of aspirin use in healthy women, demonstrate that the increased risk for hemorrhagic stroke is small, is comparable to the secondary prevention studies, and fails to achieve statistical significance.
Efficacy and Safety of Cilostazol Therapy in Ischemic Stroke: A Meta-analysis.
Indications for early aspirin use in acute ischemic stroke : A combined analysis of 40 000 randomized patients from the chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups.
TLDR
Early aspirin is of benefit for a wide range of patients, and its prompt use should be routinely considered for all patients with suspected acute ischemic stroke, mainly to reduce the risk of early recurrence.
Antithrombotic drugs and risk of hemorrhagic stroke in the general population
TLDR
Chronic low-dose aspirin treatment may have a protective effect on the risk of SAH, and warfarin users in this study cohort were at a much higher risk of ICH than those receiving no therapy, with a marked association with international normalized ratio >3.
settings : A decision analysis Aspirin for acute stroke of unknown etiology in resource-limited
TLDR
Aspirin treatment for the period of initial hospitalization after acute stroke of undetermined etiology is predicted to decrease acute stroke-related mortality and in-hospital stroke recurrence even at the highest reported proportion of acute strokes due to ICH.
Anticoagulants or antiplatelet therapy for non-rheumatic atrial fibrillation and flutter.
TLDR
Although not definitively supported by the evidence, aspirin may prove to be useful for stroke prevention in sub-groups with a low risk of stroke, with less risk of hemorrhage than with warfarin.
Aspirin for acute stroke of unknown etiology in resource-limited settings
TLDR
Aspirin treatment for the period of initial hospitalization after acute stroke of undetermined etiology is predicted to decrease acute stroke-related mortality and in-hospital stroke recurrence even at the highest reported proportion of acute strokes due to ICH.
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References

SHOWING 1-10 OF 53 REFERENCES
Controlled Trial of Aspirin in Cerebral Ischemia
TLDR
It cannot be inferred from this study that aspirin prevents stroke because when end points were restricted to death or cerebral or retinal infarction, there was no statistically significant differential between the aspirin and placebo treatments.
Aspirin and hemorrhagic stroke.
TLDR
There has been much discussion about the use of aspirin for the primary prevention of myocardial infarction, arising mainly from findings from two recent clinical trials discordant on the degree to which aspirin was beneficial.
A randomised, blinded, trial of Clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE)
TLDR
Long-term administration of clopidogrel to patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction, or vascular death.
Collaborative overview of randomised trials of antiplatelet therapy Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients
TLDR
There was no appreciable evidence that either a higher aspirin dose or any other antiplatelet regimen was more effective than medium dose aspirin in preventing vascular events, so in each of the four main high risk categories overall mortality was significantly reduced.
European Stroke Prevention Study: Effectiveness of Antiplatelet Therapy in Diabetic Patients in Secondary Prevention of Stroke
TLDR
The combination of dipyridamole and acetylsalicylic acid appeared to be more effective in nondiabetic subjects than in diabetic subjects in the prevention of death and stroke although the low number of diabetic patients may at least in part explain this result.
Dose‐Dependent Effect of Aspirin on Carotid Atherosclerosis
TLDR
The results of this study indicate that aspirin treatment slows carotid plaque growth in a dose-dependent fashion, with a dose of 900 mg daily more efficient than 50 mg daily.
A comparison of two doses of aspirin (30 mg vs. 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke.
TLDR
The data indicate that 30 mg of aspirin daily is no less effective in the prevention of vascular events than a 283-mg dose in patients with a transient ischemic attack or minor stroke, and has fewer adverse effects.
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