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To the Editor: Dr He and colleagues¹ reported a meta-analysis of collaborative trials on the risks and benefits of aspirin therapy. While they found an increased risk of hemorrhagic stroke, this risk may be outweighed by the benefits of aspirin therapy. Dr Boissel,² in an accompanying editorial, wisely emphasizes patient selection as a sensible approach, particularly in identifying candidates for primary prevention of vascular events with aspirin therapy.

The American Diabetes Association (ADA) has recently considered this issue as it relates to patients with diabetes.^3-4 Patients with diabetes have a 2- to 4-fold increase in the risk of cardiovascular death, usually from myocardial infarction. The concept that diabetes may be accompanied by a procoagulant state is supported by platelet hypersensitivity with increased thromboxane release and changes in the intrinsic coagulation and fibrinolytic system. Abnormal platelet function may contribute to coronary, peripheral vascular, and cerebrovascular thrombosis in diabetes. Primary and secondary . . . [Full Text of this Article]

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Aspirin and Risk of Hemorrhagic Stroke: A Meta-analysis of Randomized Controlled Trials
Jiang He, Paul K. Whelton, Brian Vu, and Michael J. Klag
JAMA. 1998;280(22):1930-1935.
ABSTRACT | FULL TEXT