Acetylsalicylic acid and subarachnoid hemorrhage in the Nurses' Health Study.

IF 8.7 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2025-08-01 Epub Date: 2025-03-03 DOI:10.1177/17474930251322372

Frederick Ewbank, Samuel Hall, Benjamin Gaastra, Diederik Bulters

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引用次数: 0

Abstract

Background: Acetylsalicylic acid (aspirin) is known to increase the risk of bleeding throughout the body. However, there is also evidence to suggest that acetylsalicylic acid may have a protective role in the formation and rupture of intracranial aneurysms. Previous studies investigating acetylsalicylic acid and subarachnoid hemorrhage (SAH) have so far provided conflicting results.

Aims: The aim of this study was to analyze the Nurse's Health Study (NHS) using serial assessments to evaluate differences in rates of SAH in those participants taking acetylsalicylic acid and those not taking acetylsalicylic acid while considering dose, frequency, and duration as well as different types of SAH.

Methods: The NHS is a prospective population-based cohort study of female nurses. Information on acetylsalicylic acid was first reported in 1980 until 2016 and included acetylsalicylic acid use, dose, frequency, and duration. All stroke cases were classified by physicians. Cox proportional-hazards regression models were used to estimate the hazard ratio (HR) associated with acetylsalicylic acid use.

Results: A total of 117,648 NHS participants were eligible for analysis with 357 cases of SAH observed over 4,091,239 years of follow-up. There was no association between acetylsalicylic acid use and SAH (HR = 1.02; 95% confidence interval (CI) = [0.82, 1.28], p = 0.85), aneurysmal SAH (1.04; 95% CI = [0.78, 1.39], p = 0.78), or idiopathic SAH (HR = 0.94; 95% CI = [0.65, 1.34], p = 0.72). The number of acetylsalicylic acid tablets per week was associated with SAH (HR = 1.03; 95% CI = [1.00, 1.06], p = 0.02), specifically fatal SAH (HR = 1.04 [1.00, 1.08], p = 0.03). There was no association between frequency and SAH (HR = 1.06; 95% CI = [0.99, 1.13], p = 0.07).

Conclusion: There was no evidence to support a protective association between acetylsalicylic acid and either SAH or aneurysmal SAH in female participants. In fact, there was some evidence to suggest increased SAH risk with increased acetylsalicylic acid dose in some but not all analyses.Data access statement:Data are available by request from the Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health.

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护士健康研究中的乙酰水杨酸与蛛网膜下腔出血。

背景：已知乙酰水杨酸（阿司匹林）会增加全身出血的风险。然而，也有证据表明乙酰水杨酸可能对颅内动脉瘤的形成和破裂有保护作用。先前关于乙酰水杨酸和蛛网膜下腔出血（SAH）的研究迄今为止提供了相互矛盾的结果。目的：本研究的目的是分析护士健康研究（NHS），通过一系列评估来评估服用乙酰水杨酸和不服用乙酰水杨酸的参与者在考虑剂量、频率、持续时间以及不同类型SAH的情况下SAH发生率的差异。方法：护士健康研究（NHS）是一项基于人群的前瞻性女性护士队列研究。1980年至2016年首次报告了有关乙酰水杨酸的信息，包括乙酰水杨酸的使用、剂量、使用频率和持续时间。所有中风病例均由医生分类。采用Cox比例风险回归模型估计与乙酰水杨酸使用相关的风险比（HR）。结果：共有117,648名NHS参与者符合分析条件，在4,091,239年的随访中观察到357例SAH。乙酰水杨酸的使用与SAH（危险比1.02 [0.82,1.28],p=0.85）、动脉瘤性SAH（危险比1.04 [0.78,1.39],p=0.78）或特发性SAH（危险比0.94 [0.65,1.34],p=0.72）无相关性。每周服用乙酰水杨酸片的数量与SAH相关（HR 1.03 [1.00, 1.06], p=0.02），特别是与致命性SAH相关（HR 1.04 [1.00, 1.08], p=0.03）。频率与SAH无相关性（HR 1.06 [0.99, 1.13], p=0.07）。结论：没有证据支持乙酰水杨酸与女性参与者的SAH或动脉瘤性SAH之间的保护关联。事实上，有一些证据表明，乙酰水杨酸剂量增加会增加SAH的风险，但不是所有的分析。数据访问声明：数据可通过布莱根妇女医院、哈佛医学院和哈佛陈曾熙公共卫生学院的要求获得。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.