LETTER
Aspirin for Asymptomatic Carotid Artery Stenosis
Andreas Creutzig, MD, and
Carsten Ranke, MD
1 September 1996 | Volume 125 Issue 5 | Page 420
TO THE EDITOR:
Cote and colleagues [1] present strong evidence that aspirin, 325 mg/d, does not effectively prevent ischemic events in asymptomatic patients with high-grade (
50%) carotid artery stenosis [1].
In a prospective, double-blind trial [2], we showed that aspirin treatment slows the growth of carotid plaque in a dose-dependent fashion; a dose of 900 mg/d was more efficient than 50 mg/d [2]. Twenty-seven asymptomatic patients with 104 small carotid atheroma (<50% lumen narrowing) received aspirin for 1 year; during that period they were examined with a high-resolution ultrasound duplex system. The change in plaque area was significantly different for the treatment groups: Average plaque size remained the same after treatment with 900 mg of aspirin daily but increased markedly after treatment with 50 mg of aspirin daily (P = 0.011). There were significantly more lesions that showed progression in the 50-mg group than in the 900-mg group. Ultrasonographically proven disappearance of a lesion was noted only in the 900-mg group.
We therefore agree with Cote and colleagues that a higher aspirin dose may have a beneficial effect.
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Author and Article Information
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Medizinische Hochschule, 30623 Hannover, Germany
1. Cote R, Battista RN, Abrahamowicz M, Langlois Y, Bourque F, Mackey A, et al. Lack of effect of aspirin in asymptomatic patients with carotid bruits and substantial carotid narrowing. Ann Intern Med. 1995; 123:649-55.
2. Ranke C, Hecker H, Creutzig A, Alexander K. Dose-dependent effect of aspirin on carotid atherosclerosis. Circulation. 1993; 87:1873-9.
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