Antecedent Aspirin Use Is Associated with Less Severe Symptoms on Admission for Ischemic Stroke (P1.184)

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Objective: To investigate the relationship between antecedent aspirin use and stroke severity in patients presenting with acute ischemic stroke (AIS). Background: Aspirin is known to reduce stroke risk; however, its role in reducing severity of ischemic syndrome is not clear. Prior studies showing the benefit of antecedent aspirin use on initial National Institutes of Health Stroke Scale (NIHSS) have not accounted for the acute infarct volume. Therefore, we hypothesized that, in AIS patients, presenting stroke severity as measured by baseline NIHSS is affected by antecedent aspirin use independent of acute infarct size on diffusion-weighted MRI (DWI). Design/Methods: We retrospectively analyzed a prospectively collected database of consecutive AIS patients presenting to our center. Clinical characteristics (including antecedent aspirin use), imaging findings, and laboratory data were assessed in association with presenting stroke severity, as measured by NIHSS. Logistic regression models were used to determine univariate and multivariate predictors of baseline NIHSS. Results: Of 610 AIS patients with admission brain MRI available for volumetric analysis of acute infarct size, 241 (39.5[percnt]) used aspirin prior to stroke onset. Antecedent aspirin use (p=0.0005), history of atrial fibrillation (AF) (p<0.0001), acute infarct volume (p<0.0001), initial systolic blood pressure (SBP) (p=0.041), admission glucose level (p=0.0027), and stroke subtype (p<0.0001) were associated with presenting stroke severity in univariate analysis. Antecedent aspirin use (p<0.0001), history of AF (p<0.0002), acute infarct volume (p<0.0001), SBP (p=0.038), and glucose level (p=0.0095) remained independent predictors of NIHSS in multivariable analysis. Conclusions: Antecedent aspirin use was independently associated with milder AIS severity on presentation, even after accounting for acute infarct volume. While the underlying biology of this apparently protective relationship requires further study, patients at high risk of stroke may benefit from routine aspirin use.

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