Dr. Janet L. Wilterdink

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  www.uptodate.com/home/clinicians/toc.do?full_url_key=tr - [Cached Version]
  Published on: 5/16/2009    Last Visited: 5/16/2009  

  Janet L Wilterdink, MD Deputy Editor — Neurology Senior Deputy Editor — UpToDate

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  www.uptodate.com/home/content/topic.do?topicKey=neuro_o - [Cached Version]
  Last Visited: 5/16/2009  

  Janet L Wilterdink, MD

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  ACE: Aspirin and Carotid Endarterectomy - a Randomized... - [Cached Version]
  Published on: 8/31/2006    Last Visited: 11/9/2007  

  Dr. Janet Wilterdink (Neurologist)

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  Aspirin Use May Reduce Stroke Severity - [Cached Version]
  Published on: 12/1/2001    Last Visited: 1/22/2002  

  "Up to now, studies of aspirin and other things that we do to prevent stroke have simply looked at counting up numbers of strokes that have occurred," says study author Janet Wilterdink, MD, an associate professor of neurology at Brown Medical School in Providence, Rhode Island."This study shows that in addition to reducing numbers of stroke, aspirin reduces the severity of strokes that occur as well."
  
  Wilterdink says, "Of all the strokes that occurred in the aspirin-treated patients, 50% of them were mild.Out of all the strokes in the non-aspirin-treated patients, only 43% of them were mild."
  
  She and colleagues reviewed a subset of data from a larger study, called the Trial of Org 10172 in Acute Stroke Treatment (TOAST).Investigators in that trial were studying how well a different drug could reduce the damaging effect of strokes, but they also asked about aspirin use in the last week before a stroke.
  
  Wilterdink's group decided to compare how taking aspirin compared to not taking aspirin among the participants, who all had had ischemic strokes (the kind of stroke that's caused by a blockage of normal blood flow to the brain).They found that more of the patients who had been taking aspirin had milder strokes compared to the people who had not been taking aspirin.
  
  Researchers speculate that the common white pill's known ability to thin blood and improve circulation may explain why strokes are milder in aspirin users.
  
  At least one expert says the finding provides new insight into another possible use for the already-common drug, but also says it's too early to recommend aspirin as a defense against severe strokes.

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  Aspirin appears to reduce stroke severity - [Cached Version]
  Published on: 9/23/2001    Last Visited: 7/1/2002  

  "Aspirin has a rich pharmacology, some of which is still being elucidated," says primary researcher Janet L. Wilterdink, M.D., of the department of neurology at Brown Medical School in Providence, R.I. "I believe that a combination of all these mechanisms has the potential to play a significant role in aspirin's beneficial effect."
  
  In the study, stroke severity was analyzed with two clinical neurological rating scales measuring stroke deficit at trial entry within 24 hours of stroke and again at three months.Aspirin use was defined as self-report of any use at all within seven days before stroke.Various demographic and clinical characteristics and categories of stroke subtypes were also compared between the groups, and results were adjusted for gender, race, age, and various medical conditions such as cardiac history and atherosclerosis risk factors.
  
  No information was collected about the amount or frequency of aspirin use, nor was information collected about the use of any other antiplatelet therapy or warfarin, an anticoagulant drug that inhibits platelet aggregation by interfering with blood-clotting proteins.Further, numerous factors that influence aspirin use also correlate with stroke severity; these factors may include age and prior cerebrovascular or cardiovascular history.These patients may also have received more medical attention and been more aggressively pursuing risk factor reduction.
  
  ...
  "Confounding factors such as these may play a large role in this study," Wilterdink says."We did collect a lot of information about the relative prevalence of confounding factors and controlled for them in the analysis.However, since the study was not a randomized controlled trial per se, the risk of bias is significant.
  
  Nonetheless, because there is an excellent rationale for aspirin's benefit in reducing stroke severity, it seems more likely than not that the effect is real."Because aspirin in widely known to be effective, Wilterdink doesn't feel further research will compare aspirin to placebo.
  
  "However, future studies looking at other agents in stroke prevention should measure stroke severity as well as frequency in order to obtain the best measure of the agent's efficacy," she says.

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  Church setting helps weight-loss program - [Cached Version]
  Published on: 1/8/2002    Last Visited: 1/10/2002  

  "Aspirin has a rich pharmacology, some of which is still being elucidated," said Dr. Janet Wilterdink of Brown Medical School, lead author of the study."I believe that a combination of all these mechanisms has the potential to play a significant role in aspirin's beneficial effects."Free Press news reports
  
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  Health briefs - [Cached Version]
  Published on: 1/7/2002    Last Visited: 1/8/2002  

  "Aspirin has a rich pharmacology, some of which is still being elucidated," said Dr. Janet Wilterdink of Brown Medical School, lead author of the study."I believe that a combination of all these mechanisms has the potential to play a significant role in aspirin's beneficial effects."
  
  Copyright © 2002 North Jersey Media Group Inc.Copyright infringement notice

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  HealthAtoZ - [Cached Version]
  Published on: 12/1/2001    Last Visited: 7/21/2003  

  "We used data available from a clinical trial, and we looked at stroke victims from 1990 to 1996," explains Dr. Janet Wilterdink, an associate professor of neurology at Brown Medical School in Providence, R.I. "And what we found, using measurements derived from the National Institutes of Health (NIH) Stroke scale - a point system for different kinds of neurological deficits and the severity of those deficits - was that those who took aspirin had less severe strokes."
  
  Nearly 750,000 Americans are affected by strokes every year, and about 160,000 die as a result.Symptoms include sudden blurred or decreased vision in one or both eyes, loss of balance or coordination, difficulty speaking or understanding simple statements, or weakness, numbness or paralysis in a specific body part.About 80 percent of all strokes are ischemic, caused by clots; the other 20 percent are hemorraghic, caused by broken or leaking blood vessels.
  
  Aspirin's blood-thinning effect may be in play when you have an ischemic stroke, Wilterdink says."Or what is more speculative is that aspirin may even have a neuro-protective effect.It may make the nerve cells in the brain less vulnerable to injury."Despite aspirin's growing reputation as a wonder drug, both Wilterdink and Solomon urge patients not to self-medicate."I do treat lots of patients at risk for ischemic stroke with aspirin," Wilterdink says.

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  KISC-FM Health Center - [Cached Version]
  Published on: 12/10/2001    Last Visited: 12/10/2001  

  The study of data on 1,275 people was done to bolster use of aspirin, which is recommended to prevent stroke and other cardiovascular conditions in high-risk people, says Dr. Janet L. Wilterdink, associate professor of neurology at Brown Medical School, in Providence, R.I.She is lead author of a report in the December 2001 Stroke, a journal of the American Heart Association.
  
  "Traditionally, clinical trials just count the number of strokes," Wilterdink said."That is an incomplete way of seeing how well aspirin works.It is also important to look at the severity of strokes."
  
  Wilterdink and her colleagues used data from a stroke study that began in 1990.Almost 40 percent of the patients who had strokes said they'd taken aspirin in the week before their attacks.Measuring severity by a standard National Institutes of Health scale, the researchers found that 50.3 percent of aspirin users had strokes classified as mild, compared with 43 percent of nonusers.And 9.6 percent of aspirin users had severe strokes, compared with 14.8 percent of nonusers.
  
  Wilterdink acknowledges the study has weaknesses.For example, patients were asked simply whether they had taken aspirin the week before the stroke, not whether they were taking it regularly."I suspect that most people who were taking aspirin were taking it on a daily basis," but the researchers don't know that for sure, Wilterdink said.Also, the study was limited to strokes caused by blockages and didn't include those caused by bleeding.The researchers also didn't take into account other blood-thinning or anticlotting drugs the stroke victims were taking.

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  List of Authors: Cardiology - [Cached Version]
  Last Visited: 2/10/2002  

  Janet L Wilterdink, MDAssistant ProfessorBrown University

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