Evidence Based Medicine: What is the best first agent to give to a patient with acute ischaemic stroke? Aspirin, Heparin, Clopidogrel, Cilostazol or Dipyridamole?

The International Stroke Trial (IST) and the Chinese Acute Stroke Trial (CAST) Why are these studies important and noteworthy? The International Stroke Trial and Chinese Acute Stroke Trial were two landmark trials performed to assess the efficacy of aspirin in patients with acute stroke, within 48 hours of stroke onset. The role of aspirin in secondary prevention of serious vascular events was well established, but before these two trials there was no large scale randomized evidence on aspirin in acute ischaemic stroke. The authors suggested that with several million people afflicted with ischaemic stroke every year, if only 10 or 20 per thousand could be saved from death or dependency, the overall impact would be huge. Pakistan is the sixth most populous country in the world with a population of over 120 million - translated into absolute numbers; these results have important implications for Pakistan.