Aspirin a day? Before you start (or stop) read further ...

Do you take an aspirin a day?

I used to, sometimes in combination with Plavix or warfarin as physician-directed. Aspirin sellers, of course, pitch this idea in advertising. I stopped taking it after a heart procedure that reduced my stroke risk and, with no other risk factors aside from age, my cardiologist told me it's not necessary.

Turns out that lots of people take a daily aspirin to prevent a stroke or heart attack. One recent story says a daily aspirin is taken by more than half of older U.S. adults:

Most appear to start taking daily aspirin after discussing the matter with a health care provider, said study lead author Craig Williams, a pharmacotherapy specialist at Oregon State University in Portland.

Drug combo may reduce risk of second stroke

I was on aspirin and Plavix for several years to prevent a second stroke. I eventually had a mini-stroke (or a transient ischemic attack) anyway. Still, more info to discuss with your own doctor. Check out this article about how a study shows this drug combo may reduce risk of second stroke:

After suffering a stroke or a mini-stroke, patients are usually given aspirin to prevent clots that can cause another stroke. Now a new study suggests that adding the drug Plavix (clopidogrel) to the mix can reduce the risk of a second stroke by nearly a third over aspirin alone. ...

"Giving two drugs that block platelets works a lot better than aspirin alone in people who have had a minor stroke or TIA," said researcher Dr. S. Claiborne Johnston, a professor of neurology at the University of California, San Francisco.

The trial was done in China, so whether the results would be the same in the United States isn't known. "They probably are, but we would like to see them confirmed," Johnston said.

Is closing the hole in the heart really best idea?

A recent study brings into question whether stroke survivors with a hole between the two upper chambers of the heart - called a patent foramen ovale - should have the hole patched:

Full final results from the first randomized controlled trial of patent foramen ovale (PFO) closure for stroke/transient ischemic attack (TIA) to reach completion have found no differences in the primary end point of stroke or TIA at two years, all-cause mortality at 30 days, and neurological mortality between 31 days and two years.

[Dr Anthony] Furlan [University Hospitals Case Medical Center, Cleveland] said it's "too soon to say" what impact the results will have on PFO-closure procedures: several trials are still ongoing, and while the devices are investigational in the U.S., they are market-approved in Europe and elsewhere.

"Ultimately I think CLOSURE I, if the other ongoing trials show similar results, will obviously ratchet down the number of endovascular PFO closures [performed]," he said.

"The challenge now, in my view, for the endovascular community is to refine the selection criteria and not so liberally be closing these holes in cryptogenic-stroke patients."

I have an interest in this because I had my PFO closed in 2007 and no longer take blood-thinners. Before that, I had been on both warfarin and Plavix, plus aspirin.

My understanding of my own case is that the PFO was just one of two factors; the other was an atrial septal aneurysm. That's when the wall between the two upper chambers of the heart - which normally should be fairly straight and smooth - is bulging. Basically, I was told, it had a divot, where blood clots could gather. Then, when chest pressure increases by something as simple as a sneeze, a clot could go from one side of the heart to another, through the hole, to the brain, causing a stroke.

This research points out the need to have intelligent conversations with your doctor(s) about any medical procedure, including discussion of possible outcomes, factors in your particular case, risks and alternative treatements.

Now, a 'don't fall for this' warning

One of my standard Google alerts found a link - which I won't share - that purportedly offered a medication called Aggrenox without a prescription.

That's one of the drugs - similar to Plavix - that is a potential stroke prevention tool. I was on Plavix for years and on Aggrenox for a short time before the heart procedure took me off prescription drugs entirely.

But criminal Web sites and e-mails offering potentially dangerous drugs sans prescription abound. They prey on people who need actual medical attention.

You shouldn't self-prescribe drugs like Aggrenox or Plavix. Ever.

Good news, but be cautious

Several blogs and other sources have played up news from a study written up in the journal Stroke:

Mice receiving a ginkgo biloba extract after a stroke - induced in a laboratory - suffered abouthalf the damage in mice who did not receive the extract. From one blog, here's a summary:

Extract from the leaves of the ginkgo tree offers promise to minimize brain damage caused by a stroke, scientists said on Thursday.

Mice given daily doses of ginkgo biloba extract before having a stroke induced in the laboratory suffered only about half the damage as animals not given it, researchers at Johns Hopkins University in Baltimore wrote in the journal Stroke.

Mice who did not get ginkgo before a stroke but were given it five minutes after a stroke sustained nearly 60 percent less damage in the day after the stroke than those not given ginkgo. And mice given ginkgo 4-1/2 hours after a stroke had about a third less damage than those not given ginkgo.

So this is promising news - something to follow.

One caveat, though - this isn't your over-the-counter gingko biloba. This supplement is widely marketed as a pill to help your memory and concentration. They also could interact - and not in a good way - with prescription medication for stroke prevention. Those would include warfarin, Plavix and Aggrenox.

So if you want try the supplement, talk to your doctor. For your health and safety.

All about stroke resources

An often-updated Web resource for stroke survivors, caregivers, loved ones and families: All About Stroke.

One good, educational article is about blood thinner medication - which clot-type stroke survivors often take - and the side effects. It covers aspirin, Aggrenox, warfarin, Plavix, heparin and enoxaparin, a particular form of heparin.

With the exception of enoxaparin (as far as I know), I've used them all and glad they're available to help with stroke prevention. The article does a good job of going quickly through the primary side effects to watch out for. Click on the drug names (or the photo of the pills) for additional links.

You can also sign up for an e-mail newsletter about stroke-related news from the site.

(Image from National Library of Medicine)