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Determining Proper Amount of Aspirin for Treatment

10/24/2005

Question:

Due to vertigo, my internist suggested an MRI of the brain which revealed RIGHT HIGH PARIETAL LACUNAR INFARCTION WITH MILD CEREBRAL ATROPHY. I am a 48 year old hypertensive and my doctor increased the dose of aspirin from Aspirin 75 to Aspirin 162.5 mg. Recently, I had my Endoscopy Upper GI done which revealed MILD ANTRAL GASTRITIS AND DUODENITIS IN BULB. My internist asked me to take combination i.e. clopedogril 75 and aspirin 75 because of endscopic evidence. Kindly guide me. I shall be thankful for prompt reply. The question asked is for guidance and not for diagnosis. Thanks in advance.

Answer:

Please refer to the previously answered question entitled "Help interpreting MRI" of 9/14.  This questions discusses white matter changes, such as reported in your case--a lacunar "infarct" (a small area of abnormal signal representing injury to the white matter tracts or the deep brain structures) is common in patients with long standing hypertension.  It also discusses how we think of stroke as a clinical syndrome with sudden onset of neurologic symptoms lasting >24 hours.

Regarding medication choices, it is not my place to give you too much advice since I do not know your medical history (and your doctor does).  I will make a few comments. 

It is typically not advised to use clopidogrel in combination with aspirin at this time, unless in the setting of a certain type of heart attack (non-Q wave) or in the setting of having a cardiac stent placed.  There is a recent clinical trial, called the MATCH study, which showed that clopidogrel and aspirin are not better than aspirin alone for preventing strokes (and the combination is associated with higher rates of bleeding problems).  Thus, we do not recommend this combination for stroke prevention.

There is also no evidence to suggest that higher doses of aspirin prevent strokes better than lower doses.  The FDA recommends any dose between 50mg and 325 mg daily.  You will need to be careful with aspirin doses because of thhe diagnosed gastritis annd duodenitis.  It would be optimal for you to use enteric coated aspirin (if you are not already doing so).

Beyond these general comments, it is best for you to work with your doctor on modifying your risk for stroke, including treatment of hypertension, as well as diabetes, cholesterol, and smoking cessation (if any of these apply to you).

Good luck. 

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Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati