Prestroke Aspirin Use is Associated with Clinical Outcomes in Ischemic Stroke Patients with Atherothrombosis, Small Artery Disease, and Cardioembolic Stroke

Aim: To evaluate the effect of prestroke aspirin (PA) use on initial stroke severity, early neurologic deterioration (END), stroke recurrence, hemorrhagic transformation (HT), and functional outcome in patients with ischemic stroke (IS). Methods: This was a prospective, observational, multicenter cohort study. The acute IS patients with atherothrombosis (AT), small artery disease (SAD), or cardioembolic (CE) stroke within 24 hours of symptom onset were identified. National Institutes of Health Stroke Scale (NIHSS) scores on admission, clinical outcomes (END, recurrent ischemic stroke [RIS], myocardial infarction [MI], death, and hemorrhagic episodes), and functional outcome (modified Rankin Scale [mRS] scores) at three months after admission were compared between PA users and nonusers. Results: Among the 1,862 patients, 401 (21.5%) reported PA use. The PA users had a significantly lower initial NIHSS score than the non-PA users. The effect was evident in AT stroke, but not in other subtypes. PA use was independently associated with the decreased risk of END. PA use increased the risk of HT; however, it was only associated with increased risk for asymptomatic HT, not for symptomatic HT. PA use was associated with better functional outcomes (mRS scores ≤ 2 points) irrespective of stroke subtypes at three months after admission, despite the increased risk of HT. Conclusions: PA use may reduce initial stroke severity in AT stroke and the risk of END, and can improve functional outcome at three months irrespective of stroke subtypes.