Aspirin for initial treatment and secondary prevention of acute stroke of unknown etiology in resource-constrained settings: a systematic review

ORIGINAL RESEARCH, January 2017, VOL V ISSUE I, ISSN 2042-4884
10.5083/ejcm.20424884.153 , Cite or Link Using DOI
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Izzard Aglua, Theophilus Emeto, Lachlan McIver

Abstract


Objective: This study was done to assess the safety and efficacy of aspirin in the initial treatment and secondary prevention of acute stroke of undetermined or presumed ischemic etiology.

Background: The use of aspirin for the initial treatment of acute stroke of unknown etiology in low-resource settings is often challenged by the lack of diagnostic brain imaging to confirm specific stroke type and guide treatment. Aspirin use carries a potential risk of causing or exacerbating cerebral hemorrhage which can be fatal or disabling. Hence, in developing countries only 3.8% of acute stroke patients take antiplatelet compared to 53.1% in high income countries.

Methods: A systematic review of literature from the Cochrane library, Medline, Scopus and Google Scholar was done. Studies 1) involving patients with acute stroke of undetermined or presumed ischemic etiology, 2) involving the use of aspirin in the initial treatment and/or secondary prevention of acute stroke of unknown or presumed ischemic etiology, and 3) comparing aspirin to a control or
other antiplatelet agent (s), were selected for the review.

Results: There was homogeneity of results in support of aspirin use for the initial treatment and secondary prevention of acute stroke of unknown etiology. The studies showed significant reduction in in-hospital mortality, disability, stroke recurrence and risk of hemorrhagic stroke with the use of aspirin.

Conclusion: Available evidence supported the use of aspirin for the initial treatment and secondary prevention of acute stroke of unknown or presumed ischemic etiology in resource-constrained settings, where brain imaging is unavailable to confirm stroke type.