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February 2006

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

In reply

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.