Should or should not my father take aspirin after a stroke?

A fellow caregiver asked...

My father had a major hemorrhage stroke deep in the occipital lobe of the brain on 17 December 2010. He had been taking cartia everyday upon his GP's advice until this stroke. Upon admission to the Emergency Section of the hospital, when he was having his stroke, the hospital doctor taking care of him said taking aspirin type tablets was the wrong thing to be taking for him. Dad does not have high blood pressure, cholesterol, or any complaint at all. He is on no medication. His last CT scan 2 weeks ago showed lots of scarring and some blood. No change at all to the CT scan he had just after the major hemorrhage stroke according to the radiologist report. The doctor at the hospital said the stroke was so deep in the brain there was nothing they could do but wait to see if it stopped bleeding and if it didn't they expected dad to die. Now the same local GP he has had to return to for general care is trying to put dad back on the asprin tablet daily again. I live in a town in outback Australia where we are hours from anywhere and you can't get to a specialist or have much choice of doctors. Dad is coming along so well now, he walks again, does jobs around the house such as washing dishes, cares for himself (baths, showers, toilets, dresses himself, etc) and this is from being told he may never recover the use of movement ever. Consequently, being told to go on an asprin tablet a day has really frightened dad and he is really upset and concerned. It would be appreciated if I could have some advice regarding any medication which dad should be on for prevention, or if he should just take care of himself (rest and exercise). Your advice is much appreciated. Sandra

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

This is a tough question, one for which there is no definite right or wrong answer. In general, if someone has had a bleeding stroke (such as your father), but has never had a heart attack or ischemic stroke (stroke caused by a clot in one of the arteries to the brain), I would say he should not be on aspirin. If he has had either of those in the past, then aspirin should be ok provided he keeps his blood pressure under extremely tight control.

Based on the description you gave, that his bleed was deep within the brain, my best guess is that this was a "hypertensive hemorrhage". In other words, likely due to a lifetime of having higher than normal blood pressure. If that is the case, far and away the most important thing to be done is to get that blood pressure under VERY tight control. As a general rule, if you add the systolic and diastolic blood pressure numbers together, the goal should be to have a total number of less than 200. If he gets lightheaded or woozy with blood pressure medicines, then this goal can be adjusted (of course, always due this with the guidance of your local physician). Blood pressure control, in his case, will be much more important than aspirin.

To summarize: If he has never had a heart attack, or other ischemic vascular event such as ischemic stroke, I would not give him aspirin. If he has had one of those, aspirin can be considered, but should be done only in conjunction with tight blood pressure control. In either case, he needs his blood pressure watched EXTREMELY CLOSELY.

I hope that helps. Good luck.