NATIONAL INSTITUTES OF HEALTH

National Institute of Neurological

Disorders and Stroke

EMBARGOED FOR RELEASE
Thursday, June 24, 1999
6:00 p.m. EST

Contacts:
Marcia Vital
(301) 496-5751


LOW DOSES OF ASPIRIN AND SURGERY BETTER FOR STROKE
PREVENTION

A new study shows that lower doses of aspirin given at the
time of surgery work better than higher doses to prevent
strokes.  The Aspirin and Carotid Endarterectomy (ACE)
trial, sponsored by the National Institute of Neurological
Disorders and Stroke (NINDS), found that patients given 81
or 325 mg of aspirin a day for three days before and 3
months after carotid endarterectomy (CE) surgery had less
risk of stroke, heart attack, or death 30 days and 3 months
following the surgery than did patients given 650 or 1300 mg
a day.  The study will appear in the June 26, 1999, issue of
the journal "The Lancet". 1.

"While a great deal of research has established that aspirin
reduces the risk of stroke in certain patients, the amount
of aspirin required was not clear," says Wayne D. Taylor,
M.A., a professor in the Department of Clinical Epidemiology
and Biostatistics at McMaster University in Hamilton,
Ontario, Canada, and lead author of the study.  "This study
has answered the dose question for patients who will receive
carotid endarterectomy surgery."

While the results of "The Lancet" study are strong, the
investigators warn against overgeneralizing the benefits of
low-dose aspirin for stroke prevention.  The amount of
aspirin required to prevent stroke in the 30 days after
surgery may differ from the amount of aspirin that may be
taken for years to prevent strokes in the longer-term
medical management of high-risk stroke patients.

"This trial demonstrates that lower doses of aspirin work
well," says John R. Marler, M.D., a neurologist and program
officer at the NINDS.  "This is good news because lower
doses are easier to take and better tolerated, so more
people can get the full benefit of aspirin."

The ACE trial is the first randomized clinical trial to
determine the best dose of aspirin for stroke prevention
following CE surgery.  The medical community first became
aware of aspirin's protective effects for stroke in 1978,
and, since then, several large clinical trials have shown
that aspirin reduces the risk of stroke.  The ACE trial
resulted from the observation that aspirin seemed to
decrease the risk of stroke following CE surgery in the
North American Stroke and Carotid Endarterectomy Trial
(NASCET).

For more information about the NASCET study and carotid
endarterectomy, visit the NINDS stroke information web page
at
http://www.ninds.nih.gov/healinfo/disorder/stroke/strokehp.h
tm

The NINDS is the nation's premier supporter of research on
the brain and nervous system.  It is part of the National
Institutes of Health in Bethesda, Maryland, and will
celebrate its 50th anniversary in the year 2000.

This release will be posted on EurekAlert! at
http://www.eurekalert.org and on the NINDS home page at
http://www.ninds.nih.gov/whtnwhp.htm

---------------------------------------------------------
1. Taylor, W.D.; Barnett, H.J.M.; Haynes, B.R.; Ferguson,
G.G.; Sackett, D.L.; Thorpe, K.E.; Simard, D.; Silver, F.L.;
Hachinski, V.; Clagett, G.P.; Barnes, R.; Spence, J.D. for
the ASA and Carotid Endarterectomy (ACE) Trial
Collaborators.  "A randomized trial of low and high dose
aspirin for patients undergoing carotid endarterectomy."
"The Lancet", Vol. 353, No. 9171, June 26, 1999, pp. 2179-
2184.