Prior Aspirin Therapy, Subsequent Stroke Severity and Mortality and Relationship with Cardiovascular Risk Factors in Patients Admitted to Hospital with Acute Stroke

Objective: To investigate whether the prior use of aspirin has an association with the severity and mortality of subsequent stroke and its relationship with cardiovascular risk factors. Methods: This was a study of 296 patients, with a median age of 75 years, admitted to hospital with acute stroke. Data were collected on demography, risk factors, stroke syndromes, infarct size, parameters of stroke severity and acute-phase and 90-day mortality. Patients were categorised into aspirin (n = 95) and non-aspirin (n = 201) groups, depending on whether or not they had received prior aspirin therapy. Analysis was performed to study the relationship between prior aspirin therapy, cardiovascular risk factors, previous stroke and stroke mortality. Results: Patients in the aspirin group were more disabled prior to stroke (p < 0.001) and had a higher incidence of prior stroke (p < 0.001) and ischaemic heart disease (p < 0.001). There was insignificantly higher acute-phase and 90-day mortality in the aspirin group (p = 0.13 and 0.30, respectively) in all patients. There was significantly higher acute-phase mortality among patients with ischemic strokes in the aspirin group [p = 0.02; relative risk (RR) 2.26, 95% confidence interval (CI) 1.14–4.50] and non-significantly higher 90-day mortality (p = 0.08; RR 1.50, 95% CI 0.96–2.35). The significance did not persist when previous stroke was controlled for. Patients with pre-existing cardiac failure on aspirin had higher mortality (0.001) than did patients in the non-aspirin group. Conclusions: There was a trend for higher mortality in patients with ischaemic strokes on prior aspirin therapy. This may have been due to a higher incidence of cardiovascular disease in the aspirin group. Patients with cardiac failure on aspirin had higher mortality following a stroke.