Aspirin seems better than warfarin to prevent recurrences.
THE QUESTION For decades, people who have had a stroke caused by constricted arteries in the brain have been prescribed either warfarin (Coumadin) or aspirin to prevent a recurrence. Does one work better than the other?
THIS STUDY randomly assigned 569 people over age 40 who had a stroke or a transient ischemic attack (TIA, a brief interruption of blood flow to the brain), to aspirin or warfarin. All participants had a major cranial artery that was at least 50 percent blocked. The study was halted early because of safety concerns for those given warfarin: Researchers determined that about 10 percent of those taking warfarin had died within two years, compared with about 4 percent of those on aspirin. Major hemorrhage and heart attack also were more common in the warfarin group.
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WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone who has had a stroke caused by blocked arteries, known as intracranial arterial stenosis. This causes an estimated 90,000 strokes and TIAs each year in the United States and increases the risk of a repeat attack.
CAVEATS The findings apply only to people with intracranial stenosis, not to people who take warfarin for other problems, such as irregular heart rhythm or blood clots in the legs or lungs. The high dose of aspirin used in the study -- 1,300 milligrams daily -- may increase the risk for gastrointestinal bleeding; the dose generally recommended for stroke survivors is 50 to 325 milligrams. Nine authors received fees from pharmaceutical companies.
BOTTOM LINE People with intracranial stenosis may want to talk with a doctor about aspirin.
FIND THIS STUDY March 31 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.
LEARN MORE ABOUT the causes of stroke at www.strokeassociation.organd www.ninds.nih.gov/disorders/stroke.
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THE QUESTION A pacemaker implanted in the chest can help a person whose heart beats too slowly. Some devices do this by sending electrical impulses to one of the heart's chambers; others stimulate two. Does their effect vary?