Aspirin Therapy for Stroke Prevention

Primary Prevention

The American Heart Association recommends aspirin 81 mg daily or 100 mg every other day for women over 65 years of age with controlled blood pressure and a 10-year cardiovascular risk exceeding 6-10% 3, 4, 2
Women with hypertension, hyperlipidemia, diabetes, or a 10-year cardiovascular risk ≥10% derive the most consistent benefit from aspirin therapy, according to the American College of Cardiology 3, 5
Aspirin 75-81 mg daily is reasonable for cardiovascular prophylaxis, including stroke prevention, in persons with a 10-year cardiovascular risk >10%, as stated by the American Heart Association 4, 5
The US Preventive Services Task Force supports doses as low as 75 mg daily for cardiovascular prophylaxis 3, 4

Administer aspirin 160-325 mg as a single loading dose immediately after intracranial hemorrhage is ruled out on neuroimaging, as recommended by the American Stroke Association 1
Continue with aspirin 81 mg daily for long-term secondary prevention after the acute phase, according to the American Heart Association 1
For patients with minor ischemic stroke or high-risk TIA, consider dual antiplatelet therapy with aspirin 81 mg daily plus clopidogrel 75 mg daily for 21 days, then transition to single antiplatelet therapy, as stated by the American College of Cardiology 1, 7

Always rule out intracranial hemorrhage on neuroimaging before administering aspirin, as recommended by the American Stroke Association 1, 7
Gastrointestinal bleeding risk increases with dose: 0.06% per year with aspirin versus 0.05% per year with placebo, according to the American Gastroenterological Association 3, 4