Pretreatment with aspirin and etiology of first-ever ischemic stroke in young and middle-aged patients

Abstract Background There are very limited data on the influence of pretreatment with aspirin (ASA) on the etiology of subsequent first-ever ischemic stroke. Materials and methods Five hundred ninety eight patients 65 years old or younger with first-ever ischemic stroke either pretreated ( N = 167) or not treated with aspirin ( N = 431) participated. Results The mean age was 56.5 ± 6.0 years for patients treated with ASA and 53.1 ± 8.9 years for those not treated ( p < .0001). All major vascular risk factors except smoking were significantly more frequent among the patients pretreated with aspirin. Logistic regression analysis adjustments for age, gender, and major vascular risk factors revealed an overall significant effect ( p < 0.0001) of aspirin treatment on the distribution of stroke etiologies. Subsequent separate analyses on stroke etiology subtypes indicated that the incidence of small vessel disease (SVD) related strokes was significantly reduced by pretreatment with aspirin (OR = 0.63). Logistic regression analysis showed no influence of aspirin on the likelihood of a favorable or unfavorable outcome, as expressed by Rankin scale. Conclusion Pretreatment with ASA has significant influence on the distribution of etiologies of first-ever ischemic stroke in young and middle-aged patients, when the immediate functional stroke outcome is not influenced by ASA pretreatment.