Stroke Prophylaxis Using Aspirin and Atorvastatin

Aspirin Recommendations

The American Heart Association recommends aspirin 81 mg daily or 100 mg every other day for primary stroke prevention in women over 65 years of age with controlled blood pressure when benefits outweigh bleeding risks 1, 2
Aspirin is recommended for cardiovascular prophylaxis, including stroke prevention, in men and women with a 10-year cardiovascular risk of 6-10% 1, 3
The American College of Cardiology states that aspirin is not recommended for primary stroke prevention in low-risk individuals 4, 3
Aspirin is not useful for primary stroke prevention in patients with diabetes or diabetes plus asymptomatic peripheral artery disease without other established cardiovascular disease 2, 3

Intensive lipid-lowering with high-dose atorvastatin (80 mg daily) is recommended for patients with atherosclerotic ischemic stroke or TIA to reduce the risk of recurrent stroke and cardiovascular events 5, 6
The SPARCL trial demonstrated that atorvastatin 80 mg daily reduced the risk of stroke by 16% in patients with recent stroke or TIA 6, 7

When using atorvastatin and aspirin together, monitor for potential side effects, including gastrointestinal bleeding risk with aspirin 1, 2
Liver enzyme elevations (>3 times normal) occur in approximately 2.2% of patients on atorvastatin 6

Do not combine aspirin with clopidogrel for stroke prevention unless there are specific indications, as this increases bleeding risk without additional benefit 8, 5
For patients who experience an ischemic cerebrovascular event while taking aspirin, increasing the aspirin dose has not been shown to provide additional benefit 5, 7
Avoid assuming that low-risk patients will benefit from aspirin therapy for primary stroke prevention 4, 3