We thank Dr Pijak for his comments. Risk of stroke and recurrent stroke1 is related to inflammatory markers. We agree that “rebound” inflammatory mechanisms may also play a role in the higher-than-expected increase of ischemic strokes2 and coronary syndromes3 after discontinuation of aspirin. This hypothesis is supported by the increased efficacy of aspirin in patients with high C-reactive protein levels.4 Chiang et al5 have even found that low-dose aspirin in volunteers had anti-inflammatory but not antiplatelet action. It is likely that both mechanisms, and probably even others, play a role in the antithrombotic effect of aspirin.
Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J. Rebound Inflammation and the Risk of Ischemic Stroke After Discontinuation of Aspirin Therapy—Reply. Arch Neurol. 2006;63(2):301. doi:10.1001/archneur.63.2.301