Warfarin no better than aspirin in stroke prevention

A multicentre US trial has found that the anticoagulant drug warfarin and aspirin perform equally well in preventing recurrent ischaemic stroke.

Researchers from Columbia Presbyterian Medical Center in New York followed 2206 patients who took warfarin or aspirin for two years after ischaemic stroke.

The two groups did not differ in rates of death or in ischaemic stroke recurrence, say the authors. The difference in two-year probability of an ischaemic event with warfarin vs aspirin was not statistically significant (17.8 vs 16 per cent).

The results also showed that while rates of major haemorrhage were similar, those taking warfarin had more minor haemorrhages than those taking aspirin.

This was the first trial ever to be carried out to examine whether anticoagulants – such as warfarin – are superior to antiplatelet drugs in preventing ischaemic strokes.

In this trial, aspirin – either alone or in combination with some other antiplatelet agents – appeared to be an effective choice for the prevention of recurrent ischaemic stroke. However, patients should still be advised that aspirin brings with it potential adverse effects such as gastrointestinal damage (N Engl J Med, 2001; 345: 1444-51, 1493-5).

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