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Letters
September 20, 2000

Aspirin in Acute Ischemic Stroke

Author Affiliations
 

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(11):1379. doi:10.1001/jama.284.11.1378

To the Editor: In their Editorial, Drs Mayberg and Furlan1 indicate that the current evidence does not allow clinicians to decide whether tissue-type plasminogen activator (tPA) or ancrod is better for patients with acute ischemic stroke. A more basic question is whether either treatment is better than aspirin administered in the same time period. In these trials, patients randomized to the placebo group were prohibited from receiving any antithrombotic treatments for the first 24 hours in the study of tPA2 or for the first 5 days in the study of ancrod.3 Do these protocols reflect the standard of care for such patients? Evidence now exists that aspirin may be beneficial in patients with acute ischemic stroke,4,5 but information about its administration in the first 3 hours after the onset of symptoms is limited. The question of which treatment is best needs to be addressed because a treatment as simple, inexpensive, and safe as aspirin would have broad application.

References
1.
Mayberg  MRFurlan  A Ancrod—is snake venom an antidote for stroke?  JAMA. 2000;283:2440-2442.Google Scholar
2.
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group, Tissue plasminogen activator for acute ischemic stroke.  N Engl J Med. 1995;333:1581-1587.Google Scholar
3.
Sherman  DGAtkinson  RPChippendale  T  et al.  Intravenous ancrod for treatment of acute ischemic stroke: the STAT study: a randomized controlled trial.  JAMA. 2000;283:2395-2403.Google Scholar
4.
Multicentre Acute Stroke Trial-Italy (MAST-I) Group, Randomized controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischemic stroke.  Lancet. 1995;346:1509-1514.Google Scholar
5.
Chen  ZSandercock  PPan  H  et al.  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.  Stroke. 2000;31:1240-1249.Google Scholar
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