Aspirin and cerebral infarction.

At the acute phase of cerebral infarction, two recent large studies found t hat the use of aspirin reduces both mortality and the risk of the recurrenc e of stroke. In primary prevention, aspirin nearly halves the risk of myoca rdial infarction but does not reduce that of stroke. Concerning the seconda ry prevention of atherothrombotic brain infarcts, aspirin has been the most extensively studied drug, and is efficient between 50 mg and 1,3 g. In spi te of the efficacy of other antiplatelets in this indication - ticlopidine (500 mg), clopidogrel (75 mg) and dipyridamole (400 mg) - aspirin remains t he most cost-effective, doses between 100 and 300 mg being the most widely used. Cardiac diseases with a high embolic risk require the use of oral ant icoagulation. In nonvalvular atrial fibrillation, the choice of antithrombo tic drugs depends on risk stratification: oral anticoagulants are indicated in high-risk subjects, whereas aspirin is recommended in low-risk subjects and when oral anticoagulants are contraindicated. Studies with association s of aspirin and other antiplatelets are required to increase the yield of this medication in high-risk subjects, in parallel with efforts to detect a nd to treat the vascular risk factors. (C) 2000 Editions scientifiques et m edicales Elsevier SAS.