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The chinese acute stroke trial (CAST) is the first large prospective trial to examine the short-term effects (first month post-event) of aspirin administered in the acute phase of ischemic stroke. From 1993 to 1997, 21,106 patients who were within 48 hours of their acute non-hemorrhagic stroke were randomized to receive 160 mg of aspirin upon admission to the hospital, followed by 160 mg/d for four weeks, vs. placebo.
During the study period, there were 14% fewer deaths in the aspirin therapy group than placebo (3.3% vs 3.9%; P < 0.05). There was a small but statistically significant increase in risk of intracranial bleeding in the aspirin group (0.8% vs 0.6%).
The authors calculate that about nine deaths or non-fatal strokes were avoided for every 1000 patients acutely treated with aspirin. Although the frequency of concomitant coronary artery disease and likelihood of MI complicating acute stroke is distinctly less in Chinese populations than others, the authors also indicate that in other, more coronary-prone populations, one additional life per thousand would be likely saved by this intervention as a result of reduction in coronary mortality.
CAST Collaborative Group. Lancet 1997;349:1641-1649.