Background: We evaluated whether the risk of stroke depends on aspirin dose
in patients with a previous transient ischemic attack or stroke.
Methods: We conducted a metaregression analysis of stroke by using publishe
d randomized, placebo-controlled trials. We analyzed studies of patients wh
o had recently had a transient ischemic attack or stroke (ie, secondary pre
vention). We abstracted data on the treatment regimen and stroke. To evalua
te the dose-response relationship, we conducted a metaregression analysis o
f study-specific risk ratios by means of weighted linear regression.
Results: Eleven randomized, placebo-controlled trials contributed a total o
f 5228 patients randomized to aspirin only and 4401 patients randomized to
placebo only. The slope of the dose-response curve was virtually flat acros
s a nide range of aspirin doses from 50 to 1500 mg/d (P = .49 for test of s
lope not equal 0). Summarizing across studies, aspirin decreases the risk o
f stroke by about 15% (risk ratio, 0.85; 95% confidence interval, 0.77-0.94
).
Conclusions: Aspirin reduces the risk of stroke by approximately 15%, and t
his effect is uniform across aspirin doses from 50 to 1500 mg/d. The lowest
effective aspirin dose has not yet been identified, but it could be lower
than 50 mg/d.