Aspirin....reduced rupture risk....anyone else see this?

From Medscape Medical News > Neurology

Aspirin May Protect Against Intracranial Aneurysm Rupture

Megan Brooks

Authors and Disclosures

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November 7, 2011 — Regular use of aspirin may reduce the risk for intracranial aneurysm (IA) rupture, new observational results suggest.

In a group of patients with unruptured aneurysms followed-up for 5 years, those using aspirin at least 3 times a week had a lower likelihood of aneurysmal subarachnoid hemorrhage (SAH) relative to those who did not use aspirin.

"Recent studies on IAs have strengthened the concept that chronic inflammation plays a significant role in aneurysm formation and potentially predisposes to IA wall degeneration and rupture," David M. Hasan, MD, from the Department of Neurosurgery, University of Iowa, Iowa City, and colleagues note in an article published online October 6 inStroke.

The current findings, the authors say, provide epidemiological evidence of an association of frequent aspirin use and reduced incidence of aneurysmal SAH and warrant further study.

In a linked commentary, Michael Tymianski, MD, PhD, FRCSC, from the Division of Neurosurgery, Toronto Western Hospital, Ontario, Canada, agrees that further study is needed before any firm conclusions are drawn.

The association of reduced odds of sustaining an aneurysmal SAH with increased aspirin use "should not, at this stage, be interpreted as a suggestion that aspirin use is of overall clinical value in patients with IAs," Dr. Tymianski writes.

"[T]he possibility of a more adverse clinical outcome in the event of a SAH should be weighed against the possibility of a reduced likelihood of a SAH," he notes.

The ISUIA Cohort

Dr. Hasan and colleagues selected 1691 patients from the prospective untreated cohort of the International Study for Unruptured Intracranial Aneurysms (ISUIA).

Of these patients, 58 had a proven aneurysmal SAH during a 5-year follow-up. Each of these case patients was matched by study site and size of aneurysm to 4 control participants (213 control patients).

In the initial bivariable analysis, a trend of a protective effect for risk for UIA rupture was observed, according to frequency of aspirin use.

Table. Risk for Rupture of Unruptured Aneurysms With Aspirin Use vs No Use

Aspirin Use Odds Ratio for SAH (95% Confidence Interval)
3 times a week to daily 0.40 (0.18 - 0.87)
<1 time a month 0.80 (0.31 - 2.05)
From >1 time a month to 2 times a week 0.87 (0.27 - 2.81)

In multivariable analysis, patients who used aspirin 3 times weekly to daily had a significantly lower odds of hemorrhage (adjusted odds ratio, 0.27; 95% confidence interval, 0.11 - 0.67; P = .03) relative to those who did not use aspirin.

"Intriguing but Unproven"

In their report, Dr. Hasan and colleagues note that aspirin has inhibitory effects at "several steps in the inflammatory cascade implicated in cerebral aneurysm pathophysiology." Thus, it does have "potential as a therapeutic agent to prevent cerebral aneurysm growth and rupture."

In his commentary, Dr. Tymianski says the possibility that reducing inflammation may reduce hemorrhage risk is "intriguing but unproven," and that the data in this study are "at best an indirect indication in support of this hypothesis."

He says it is unclear from the data whether regular use of aspirin actually affected inflammation, or whether other actions of aspirin such as a reduction in platelet aggregation may have played a role in affecting hemorrhage risk.

The data also cannot rule out a healthy user bias: Regular aspirin users may be more attentive to their health and perhaps have better blood pressure control, for example, Dr. Tymianski says.

Although the authors did use multivariable regression approaches to examine these issues, in this "underpowered data set, these analyses do not exclude these alternative explanations," he writes. Nonetheless, the findings remain "most intriguing," Dr. Tymianski says, and should be explored further.

Dr. Hasan and colleagues suggest studies in animal models of cerebral aneurysms to study the mechanism of the effect of aspirin on the inflammatory process implicated in aneurysm formation and rupture, further observational data from other cohorts or aspirin clinical trials for other end points, and a clinical trial exploring the effect of aspirin on cerebral aneurysms that are chosen to be followed without interventional treatment.

The ISUIA was supported by the National Institute of Neurological Disorders and Stroke. Dr. Hasan and colleagues have disclosed no relevant financial relationships. Dr. Tymianski is president and chief executive officer of NoNO Inc, a company dedicated to the development of neuroprotectants discovered in his academic laboratory.

Stroke. 2011;42:3156-3162. Full text, Editorial

Medscape Medical News © 2011 WebMD, LLC
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I just found this tonight - it's a recent research article.

Has anybody's doctor discussed this with them? I don't see my surgeon again for 6mos, and will ask about it then, but am wondering if this has been recommended to anyone. Makes me seriously consider taking at least baby aspirin....

Obviously none of us should make this choice without consulting the doctor....but it sounds worthy of discussion.


Interesting article. I have been prescribed asprin on a daily basis since I had my aneurysm coiled in January of this year and I understand that this is common practice here in the UK. It is thought to reduce the risk of stroke/rupture for aneurysm patients.

Interesting article Jaycie, I was put on 81 mg aspirin the day my annies were found and my neurosurgeon told me I'd be on aspirin regimen for the rest of my life.

Same with me, I am on 75mg and was told that it would be a life-time requirement.

I was only on aspirin (and plavix) for the 8 weeks post surgery, then nothing. Maybe I'll call tomorrow and see what he says - I have one coiled and 2 being monitored, so I'd do anything to prevent rupture!

HI Jaycie...

I am unsure what happened to my reponse...I think it didn't take, anyways, I am on 325 mg of aspirin the rest of my life...! Told this was so important ...

If I were you ... I would check with my Doctors...!

Keep us posted...great article...cyber~hugs Colleen

Hi Jaycie,

Thanks for sharing the article. I am on 325mg aspirin for the rest of my life.


Me too - I'm on 325mg asiprin and was told to get used to's for life. Glad to see at least the beginning of confirmation. Thanks for posting!

Jaycie, I wouldn't wait I hope you called and they said "go ahead" and not to wait 6 months before getting that regimen started.


Curious - do any of you who do take aspirin have other risk factors...high cholesterol, high BP etc? I have no risk factors and can't figure why on earth my doc didn't put me on aspirin....


I started plavix and 325 aspirin sept 19 of this year i'll take the plavix for 6 months and aspirin forever. i just had my blood count checked by my pcp because i'm covered in bruises and petichaie ( tiny purple pinpoint dots) . she asked if I was feeling tired. i'm always tired lately . I think my memory might be starting to get a little better but I can't reme,ber how many things i forgot yesterday . lol

Hi Jaycie...I have great arteries I am told...other than my annies...I do have High Bp that is being controlled by high cholesterol, no bad heart, etc., stomach problems I have, and aspirin makes it so much better...Me being smart with that comment...hahaha...! When I told surgeon that I have stomach issues for years and the aspirin sorta making things worse...he replied very curt, "do u want to live or not?"...nice huh? I just assumed everyone on aspirin for life...I would have been on plavix for another 6 months after surgery, but well you you I bled...low blood counts....

Happy Thanksgiving to you and your family...!

Love and hugs Colleen

What a jerk your doc was to say that to you!

I'm really questioning why my surgeon didn't have me stay on aspirin. Will call on Monday - in the meantime am going to take it since I know it can't hurt.


Those of you who are on Asprin, are you taking dispersable asprin or enteric coated asprin? I was put on dispersible asprin after having my anneurysm coiled in January but when I saw my endocrinologist earlier this week he advised me to change to enteric coated tablets. Apparently if you have blood pressure issues you are safer taking an enteric coated tablets as they are absorbed more slowly and considered safer to take.

Hi Caro...Doc's told me the same...I buy Bayer Aspirin that is safety coated and enteric coated capsules...I too have high blood pressure, but controlled with meds...

Wow thanks for the tip!