Aspirin as good as warfarin at reducing stroke risk

Reported by Susan Aldridge, PhD, medical journalist

A comparison trial shows that aspirin is as effective as warfarin in reducing stroke risk, but has fewer side effects.
Intracranial stenosis is a condition involving impairment of the blood supply to the brain when fatty deposits - atherosclerosis - built up in blood vessels. It is responsible for about ten per cent of strokes and transient ischemic attacks. Those who have had such an event are at increased risk of having another one. Medication like warfarin or aspirin, which thin the blood, may reduce this risk.

In a new study, a group of 569 patients who had had a stroke took either warfarin or aspirin for an average of 1.8 years. Around 22 per cent of the patients went on to have another stroke. But the rate of major hemorrhage and death from all causes was higher in the warfarin group. This is not unexpected, for warfarin is linked with bleeding as a side effect. Those on warfarin require continuous monitoring for this reason. The dose of aspirin used in this study was high - 1300 milligrams - but it was as effective as warfarin. This may prove controversial as many physicians believe that 325 milligrams a day is the highest dose that should be taken. The relatively high risk of stroke in this trial also reflects the dangers of intracranial stenosis. Clearly this is a condition for which more therapies are needed. In the meantime, aspirin is cheap and simple to take and may offer new hope to these patients. However, patients on aspirin already should not increase their dose without consulting their physician.

Source
New England Journal of Medicine 31st March 2005

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