Claris Law Legal Blogging Community

Editor: Robert Blanchard
Profession: Attorney at Law

Users of the Ortho Evra birth control patch may wonder if their stroke was cause by something other than the estrogen. Here is one possibility I read about: Stopping Aspirin May Cause Strokes.

Aspirin is the mainstay of primary and secondary stroke prevention. The rate of cerebrovascular events such as ischemic stroke and TIA after discontinuation of aspirin has not been clearly studied in a case-controlled fashion. Aspirin is usually discontinued before elective surgical procedures, because it increases complications by prolonging bleeding times and increasing operative blood loss. Anecdotal evidence indicates that strokes can occur when patients discontinue either warfarin or aspirin. It is not clear, however, whether this apparent association is coincidence, a result of transient hypercoagulability from surgical procedures, or caused primarily by the discontinuation of antithrombotic medication.

The assumed cause of the increased rate of stroke and TIA after halting aspirin is a rebound prothrombotic effect. Experimental studies quoted in the article by Maulaz et al. suggest that this effect can occur 8-21 days after halting aspirin use, and many clinicians feel that withholding aspirin for 5-7 days is risk-free when compared with the low risk of aspirin complicating procedures such as endoscopy or conventional angiography. Most concerning in the present study was the short duration of time that elapsed between the stopping of aspirin and the onset of TIA or stroke-six patients had a stroke within 5 days, and 70% of the strokes occurred in less than 10 days after discontinuation of aspirin. As this is a population-based study analyzing risk, an etiology for the observed strokes can only be surmised. The findings serve as reasonable evidence, however, that interruption of aspirin therapy should be carefully weighed against the risks, and that compliance with aspirin on the patient's part is vital. Other literature supports this view and suggests that continuation of aspirin or the rapid reintroduction of aspirin after coronary artery bypass graft surgery might in fact be beneficial.