Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA.
Stroke. 2013 Feb;44(2):432-6. doi: 10.1161/STROKEAHA.112.672451. Epub 2013 Jan 10.
Although aspirin is effective in prevention of stroke, fewer studies have examined the impact of aspirin on stroke morbidity.
The Women's Health Study is a completed randomized, placebo-controlled trial designed to test the effect of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer, which enrolled 39 876 women. We used multinomial logistic regression to evaluate the relationship between randomized aspirin assignment and functional outcomes from stroke. Possible functional outcomes were neither stroke nor transient ischemic attack (TIA), modified Rankin scale (mRS) score 0 to 1, 2 to 3, and 4 to 6.
After a mean of 9.9 years of follow-up, 460 confirmed strokes (366 ischemic, 90 hemorrhagic, and 4 unknown type) and 405 confirmed TIAs occurred. With regard to total and ischemic stroke, women who were randomized to aspirin had a nonsignificant decrease in risk of any outcome compared to women not randomized to aspirin. This decrease in risk only reached statistical significance for those experiencing TIA compared to participants without stroke or TIA (odds ratio=0.77; 95% confidence interval, 0.63-0.94). For hemorrhagic stroke, a nonsignificant increase in the risk of achieving an mRS score 2 to 3 or 4 to 6 compared with no stroke or TIA was observed for the women randomized to aspirin compared to those randomized to placebo.
Results from this large randomized clinical trial provide evidence that 100 mg of aspirin every other day may reduce the risk of ischemic cerebral vascular events but does not have differential effects on functional outcomes from stroke.
尽管阿司匹林在预防中风方面有效，但较少有研究探讨阿司匹林对中风发病率的影响。
妇女健康研究是一项已完成的随机、安慰剂对照试验，旨在测试低剂量阿司匹林和维生素 E 在心血管疾病和癌症一级预防中的作用，共纳入 39876 名女性。我们使用多项逻辑回归来评估随机分配阿司匹林与中风功能结局之间的关系。可能的功能结局为无中风或短暂性脑缺血发作（TIA）、改良 Rankin 量表（mRS）评分 0-1、2-3 和 4-6。
平均随访 9.9 年后，发生了 460 例确诊中风（366 例缺血性、90 例出血性和 4 例未知类型）和 405 例确诊 TIA。对于总中风和缺血性中风，与未随机分配阿司匹林的女性相比，随机分配阿司匹林的女性任何结局的风险无显著降低。与无中风或 TIA的参与者相比，这种风险降低仅在 TIA 患者中达到统计学意义（比值比=0.77；95%置信区间，0.63-0.94）。对于出血性中风，与无中风或 TIA相比，随机分配阿司匹林的女性发生 mRS 评分 2-3 或 4-6 的风险无显著增加。
这项大型随机临床试验的结果提供了证据，表明每天服用 100 毫克阿司匹林可能会降低缺血性脑血管事件的风险，但对中风的功能结局没有差异影响。
