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Study suggests antithrombotics cause more intracerebral hemorrhagic stroke deaths in 'over-75s'

ntracerebral haemorrhage in older patients that should have occurred due to falling average blood pressures over the 25 years.

The authors say their findings suggest that increasing use of antithrombotic agents may soon overtake poorly controlled blood pressure as the major risk factor for intracerebral haemorrhagic stroke in the over 75s.

The authors conclude: "This potential rise in the burden of intracerebral haemorrhage would not have been predicted from previous studies of mortality data, which were limited to the population under 75 years.

"Since at least two thirds of cases of intracerebral haemorrhage and 50% of all strokes occur above this age, it is essential to include the older population in studies of stroke.

"Antithrombotic drugs, such as aspirin, are undoubtedly of overall benefit in older patients with a definite indication, such as a previous heart attack or stroke, but our results emphasise the need for caution in advising widespread use of daily prophylactic aspirin in healthy older people who are not known to have vascular disease."

In an accompanying comment, Dr Dawn Kleindorfer, director of the Stroke Prevention Programme Greater Cincinnati/Northern Kentucky, USA, says: "Stabilisation of the incidence of stroke, especially the high morbidity and mortality associated subtybe of intracerebral haemorrhagic stroke, is not good news. As our population continues to age, the actual number of events will continue to increase, and overwhelm our already overburdened healthcare systems.

"We need to find new and better ways to prevent stroke and change behaviour of patients and physicians so that this stable incidence trend does not continue."


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Contact: Peter Rothwell
peter.rothwell@clneuro.ox.ac.uk
44-186-561-7158
Lancet
30-Apr-2007


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