What are the alternatives to Aspirin in Stroke Patients?

Here is a question we received through our Ask Your Question Page.


I am living in Australia and my father recently had a stroke. My father is 68 years old. He is a patient with diabetes, cholesterol and high blood pressure. He was used to smoke. Now he is taking Aspirin on his doctors advice. On my research in the internet I found the below information. It says daily Aspirin is no longer recommended in patients more than 60 years. What alternatives does my father have?

Upul from Australia (See below for the photo he sent)
The photo of the article sent by Upul.


While it is important to speak with a healthcare professional to determine the best course of action for your father’s specific health conditions and needs let us give you few clarifications.


The article you have sent gives facts on the Aspirin use in patients who have not had any stroke or ischemic heart disease. Earlier Aspirin was recommended to prevent first attack of stroke or heart attacks. However, later the guidelines was changed on evidence from multiple researches and now no longer Aspirin is not generally recommended to prevent strokes and heart attacks in patients who never had those. This is relevant to patients who have one or more risk factors for cardiovascular diseases.


The common risk factors for strokes and heart attacks (ischemic heart diseases are diabetes, high blood pressure, lipid abnormalities, smoking, family history of strokes, ischemic heart diseases, etc. Your father has few of these risk factors and he has already got a stroke.


Once a stroke happen, the management of patient is to prevent further attacks by optimal management of the risk factors. We have to aim to control blood sugar, high blood pressure, cholesterol levels. Further, it is important that patient stop smoking and cut down the use of alcohol.


Preventing a further attack once a stroke or heart attack has already happened is called secondary prevention. Most of the guidelines in the world recommends the patients to take statins and antiplatelets medications.


Aspirin is such antiplatelet medications and there is a specific purpose for giving these medications. Antiplatelet medications prevent blood clots from forming in blood vessels. Some other examples of antiplatelets medications include clopidogrel, prasugrel and ticagrelor. These medications work by interfering with the platelets in the blood and making it more difficult for them to stick together and form clots. The choice of antiplatelet medication and the duration of treatment will depend on various factors such as the individual’s medical history, other medications they may be taking, and their overall health status. Sometimes, two antiplatelet medications (duel antiplatelet therapy) are given in selected patients. A doctor can provide personalized recommendations based on a patient’s individual situation.


To answer your question, your dad has to take at least one antiplatelet medication and Aspirin is such medication. It is cheaper and commonly available medication and it has shown the benefit this group of patients. In Sri Lanka these days during the economic crisis (Jan-Feb 2023) there is scarcity of some medications. Unfortunately, Aspirin is such medications that patients find it difficult to get from pharmacies.


It is important that a stroke patient go through the rehabilitation process. Most of the patients recover from the stroke with proper management. It is important that a stroke patient with residual disabilities join a rehabilitation program under a physiotherapists. Further, it is important to address those problems in bowel and bladder function if they are present. Swallowing may be difficult in some stroke patients and the family members have to be cautious about the aspiration risk when feeding these patients.


Stroke rehabilitation involve many health care professionals. As mentioned earlier, physiotherapist provide physical therapy. Speech therapists can help with swallowing issues, and communication issues. Emotional support is very important in these patients and they need help to cope with the physical and emotional changes that may result from stroke.


We are glad that you asked this question before making a decision. It is not easy to make safe treatment decisions through google search. Doctors have gone through the proper training. They consider many factors when deciding on treatment and many factors are taken into considerations when they make treatment decisions.


Your father ideally need to have a family physician. He will coordinate the necessary special care by arranging above services and referring to a neurologist.

In Sri Lanka, most of the stroke patients seek a rapid cure and seek help from practitioners who claim that they cure strokes. It is important to note that some of these people may not be qualified and honest practitioners.


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