Studies have demonstrated a modest benefit of aspirin in acute stroke (Chen et al., 2000), and current guidelines advise prompt use of aspirin in acute stroke (Adams et al., 2003) even if an urgent CT scan is not possible and an ischaemic stroke is thought likely. We wished to study the timing of aspirin prescription in stroke to determine if there was a significant difference between patients admitted to an acute stroke unit (ASU) directly or via a general medical ward. We also analysed the prescription of secondary preventive therapies known to benefit stroke patients such as statins, thiazide diuretics and ACE inhibitors (MacWalter et al., 2002).

A retrospective analysis was performed on the medical notes and prescription records of 60 patients admitted to an ASU over a 3 month period to establish timing of aspirin prescription with respect to onset of stroke symptoms, timing of CT brain scan and route of admission to the ASU at Aberdeen Royal Infirmary. Data are expressed as median values plus interquartile range and the ² and Mann-Whitney tests were used. Treatment with appropriate secondary prevention was also determined.

CT scans were obtained in 95% of patients a median of 2.1 days post stroke (IQ range 1.25-3.53). 63% of patients received aspirin as an acute treatment of stroke. Patients given aspirin as a new treatment received aspirin earlier post admission if directly admitted to the ASU compared to those admitted via a medical ward (0.7 vs 2.1 days respectively, p<0.05) and were also more likely to receive aspirin prior to CT scan being performed than those admitted via a medical ward (64% vs 21%, p<0.05, ² test). Stroke patients who were already taking aspirin on admission were also more likely to have this stopped on admission if they were admitted to a medical unit than if admitted directly to the ASU (73.3% vs 16.7% respectively, p=0.018, ² test).81% of ischaemic stroke patients were discharged on a statin, 90% on antiplatelet therapy, 35% on an ACE inhibitor or angiotensin II antagonist and 38% on a thiazide diuretic.

Aspirin was given more promptly in acute ischaemic stroke and more commonly prior to CT scanning in an ASU compared to a medical ward. Statin therapy is used extensively in hospitalized stroke patients but there is a much lower rate of initiation of other secondary preventive therapies, such as thiazide diuretics and ACE inhibitors. This may demonstrate a hesitancy in early use of aspirin amongst general physicians and lends support for the use of stroke units and better adherence to guidelines for stroke patients on all units.

Adams et al.(2003), Guidelines for the early management of patients with ischaemic stroke. Stroke 34:1056-83.
Chen ZM et al.(2000), Indications for early aspirin use in acute ischemic stroke: A combined analysis of 40 000 randomized patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke, 31(6):1240-9.
MacWalter et al., (2002), A Benefit-Risk Assessment of Agents Used in the Secondary Prevention of Stroke. Drug Safety, 25(13):943-963.