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People who have had a stroke are often prescribed a daily aspirin to help prevent future strokes. But aspirin may not target the underlying cause of lacunar ischemic strokes, a common type of stroke tied to damage in the brain’s smallest blood vessels.
Researchers say that lacunar strokes, which are small, deep-brain strokes, may require more targeted therapies than standard treatments like aspirin or statins.
Why Aspirin May Not Work Well for a Lacunar Stroke
In the study, researchers analyzed data from 229 people and found that lacunar ischemic strokes were more strongly linked to widening and damage in the brain’s small blood vessels than to plaque buildup in larger arteries. Close to 90% of all strokes are ischemic, and a quarter of those are lacunar.
“Patients who have had an ischemic stroke are usually asked to take an aspirin each day thereafter to prevent another stroke,” Joanna Wardlaw, MD, senior author of the study and clinical director of the Centre for Vascular Dementia Research, told Verywell in an email.
While aspirin is effective at preventing strokes caused by plaque buildup, it appears to offer less protection against strokes linked to small vessel disease, Wardlaw said.
Most strokes happen when a blood vessel in the brain bursts, or blood flow to the brain is blocked by a clot. One common cause is fatty plaque buildup inside an artery. If the plaque ruptures, blood rushes to the site to form a clot, as it does when you get a cut on your skin.
“A big blood clot can form, which will eventually block off that whole blood vessel. It’s a good response when you cut yourself, but it’s a bad response in the brain and heart where size matters for how much blood goes through,” Eric Goldstein, MD, FAHA, a vascular neurologist and neurohospitalist at Detroit-based Henry Ford Health and the neurology medical director for the Henry Ford Macomb Hospital Stroke Center, told Verywell.
Aspirin, a blood thinner, helps lower the risk of clot formation in these situations. But it’s less clear whether aspirin works as well when a stroke is caused by damage to the brain’s small blood vessels rather than plaque buildup, Goldstein said.
Aspirin Is Still the Best Available Treatment
About one in four people will experience another stroke after their first one, and they may have a different type of stroke the second time around.
Aspirin is still the best treatment available at the moment, but more clinical trials are underway to test more effective treatments that target small vessel disease directly, according to Wardlaw.
People who have a small vessel stroke are at risk for other types of stroke, including large vessel stroke. Data shows that aspirin and other antiplatelet therapies help prevent recurrent stroke of different mechanisms, said Anjail Sharrief, MD, an American Stroke Association volunteer expert and professor and director of stroke prevention at UTHealth Houston.
The new findings suggest that other therapies might work better for preventing a second stroke after a lacunar stroke, but this has not been proven.
“For prevention of stroke after someone has already had a stroke, the current best evidence-based treatment is antiplatelet therapy, typically aspirin, combined with really aggressive blood pressure control,” Sharrief said.
Aspirin Is Mainly for Preventing a Second Stroke
Aspirin is important for secondary stroke prevention, but it increases the risk of bleeding, so it is not always recommended for people without a history of stroke.
“If someone is trying to prevent a first-time stroke, we don’t know if aspirin is helpful, and that should be a case-by-case discussion with your doctor or neurologist. But classically, people who have not had a stroke do not need aspirin,” Goldstein said.
Managing blood pressure, following a healthy dietary pattern, getting enough exercise, maintaining a healthy weight, cutting out smoking, and reducing alcohol consumption are all more helpful for lowering your chances of a first stroke.
Read the original article on Verywell Health
