Stroke risk factors in an African population: a report from Sierra Leone.

Hemorrhage in Double-Blind Clinical Trials Daily aspirin dose None 30 mg 75 mg 300 mg 1,200 mg UK-TIA' 2 ... ... 7 7 Dutch TIA2 ... 13 ... 15* SALT4 3 ... 8 ... USPHS' 12 ... ... 23* *283 mg in Dutch TIA trial; 325 mg every other day in USPHS.mg/day.It is problematic whether this difference in antithrombotic effect, based on microvascular or venous bleeding, is relevant in ischemic stroke prevention.Pooling data from several trials, aspirin appears to double the risk of intracerebral hemorrhage in patients with cerebrovascular disease (Table 2),3 although this has not been statistically signifi- cant in individual cerebrovascular trials.Oddly, this appears to occur with doses as low as 75 mg/day.4The data relating the dose of aspirin to the frequency of intracerebral hemorrhage include fewer outcome events than those pertaining to non-GI minor hemorrhage, but there appears to be no difference between 30 mg and 1,200 mg/day on the relative risk of brain hemorrhage.Is there really an important difference in efficacy between doses of aspirin in patients with cerebrovascular disease?The in vivo effect on non-GI minor bleeding would support this idea, yet the increase in intracerebral hemorrhage (albeit with fewer end points for analysis) is seemingly not dose dependent.The optimal dose of aspirin for prevention of stroke is a continuing controversy, "a riddle wrapped in a mystery inside an enigma."6