Most important, in the above study, aspirin did not prevent fatal stroke rates. The pathophysiologic mechan¬ism causing fatal stroke and heart attack is similar. An atheromatous plaque undergoes erosion or rupture liberating a porridge like material that is intensely thrombogenic and the thrombus cannot be ameliorated by aspirin or other antiplatelet agents that do not affect the culprit thrombotic factors. In the study transient ischemic attacks (TIAs) were significantly reduced, however. This finding is not surprising because TIAs are caused by platelet emboli and platelet thrombi have been shown in randomised clinical trials to be significantly prevented by antiplatelet agents such as Plavix or the combination of aspirin and dipyrimadole. A small stroke represents the continuation process of a transient ischemic attack some of which can be prevented therefore by aspirin or other antiplatelet agent.
Women ages 45–64 who have more than one cardiovas¬cular risk factor should benefit significantly in the prevention of nonfatal strokes and TIAs with the use of small dose aspirin, 75–81 mg enteric-coated daily. Those with two or more risk factors may benefit from risk of heart attack. The above study used 100 mg alternate day and this may not be an adequate dose to prevent non fatal heart attacks. (See the chapter entitled Stroke/Cerebro-vascular Accident.)

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