If you fail to give aspirin to stroke patients in your ED, you’re not following recommendations of a recent report from the St. Paul, MN-based American Academy of Neurology and the Dallas-based American Stroke Association. According to the report, all acute ischemic strokes have the potential to benefit from early aspirin administration, says Dawn K. Beland, RN, MSN, CCRN, CS, stroke center coordinator at The Stroke Center at Hartford (CT) Hospital.
Administer within 48 hours
To reduce the patient’s chance of having another stroke, you should give 160 to 325 mg of aspirin within 48 hours of symptom onset, if there are no contraindications such as allergy and gastrointestinal bleeding and the patient will not be treated with recombinant tissue-type plasminogen activator, she advises.
She points to this compelling statistic from the report: "It was estimated that 13 more patients were alive and independent for every 1,000 patients treated with antiplatelet agents."1
Because some patients may be unable to take anything by mouth after the onset of stroke, an aspirin dose also may be given by way of rectum, notes Beland. However, you should not give aspirin until after the noncontrast head computerized tomography scan has been read and hemorrhagic stroke ruled out, she says. "Giving aspirin within 48 hours of symptom onset does increase the risk of hemorrhage, but the benefits of reducing death, disability, and early recurrent stroke are worth the risk," says Beland.
1. Coull BM, Williams LS, Goldstein LB, et al. Anticoagulants and antiplatelet agents in acute ischemic stroke: Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association). Neurology 2002; 59:13-22.
For more information on giving aspirin to stroke patients, contact:
• Dawn K. Beland, RN, MSN, CCRN, CS, Stroke Center Coordinator, The Stroke Center at Hartford Hospital, 80 Seymour St., Hartford, CT 06106-5037. Telephone: (860) 545-2183. Fax: (860) 545-5062. E-mail: firstname.lastname@example.org.