"Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) Trial". The New England Journal of Medicine. Date Unknown. Pages Unknown. PubMed•Full
Links to original sources: Wiki Journal Post Full Journal Article
Contents 1 Clinical Question 2 Bottom Line 3 Major Points 4 Guidelines 5 Design 6 Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7 Interventions 8 Outcomes 8.1 Primary Outcomes 8.2 Secondary Outcomes 9 Criticisms 10 Funding 11 Further Reading
In patients with symptomatic intracranial arterial stenosis, which antithrombotic treatment is more effective: aspirin or warfarin?
Aspirin should be used in preference to warfarin for patients with symptomatic intracranial arterial stenosis as warfarin is associated with higher rates of adverse events and provides no additional benefit over aspirin.
The WASID trial compared aspirin with warfarin in patients with symptomatic intracranial arterial stenosis and found that warfarin was associated with significantly higher rates of death, major hemorrhage, and myocardial infarction/sudden death without any added benefit over aspirin for preventing stroke or vascular death.
As a result of this trial, aspirin is recommended over warfarin in the treatment of symptomatic intracranial arterial stenosis.
Multicenter, double-blind, parallel group, randomized, placebo-controlled trial.
569 patients with symptomatic 50 to 99 percent intracranial arterial stenosis (carotid, middle cerebral, vertebral, or basilar arteries) confirmed by angiography.
Inclusion Criteria Patients with transient ischemic attack or nondisabling stroke within 90 days before randomization, attributable to angiographically verified 50 to 99 percent stenosis of a major intracranial artery, with a modified Rankin score of 3 or less, and aged at least 40 years.
Exclusion Criteria Exclusion criteria included tandem 50 to 99 percent stenosis of extracranial carotid artery, nonatherosclerotic stenosis of intracranial artery, cardiac source of embolism, contraindication to aspirin or warfarin therapy, indication for heparin post-randomization, and coexisting condition limiting survival to less than five years.
Baseline Characteristics Comparable across treatment groups with a mean follow-up period of 1.8 years.
Patients were randomly assigned to receive warfarin (target INR, 2.0 to 3.0) or aspirin (1300 mg per day).
- The primary end point occurred in 22.1 percent of the aspirin group and 21.8 percent of the warfarin group (hazard ratio, 1.04; P=0.83). - Rates of death from any cause were 4.3 percent in the aspirin group versus 9.7 percent in the warfarin group (hazard ratio, 0.46; P=0.02). - Rates of major hemorrhage were 3.2 percent in the aspirin group versus 8.3 percent in the warfarin group (hazard ratio, 0.39; P=0.01).
- No significant differences between treatment groups in rates of ischemic stroke in any vascular territory, ischemic stroke in the territory of the stenotic intracranial artery, or composite of ischemic stroke, death from vascular causes other than stroke, or nonfatal myocardial infarction. - Rate of major cardiac events (myocardial infarction or sudden death) was significantly higher in the warfarin group (hazard ratio, 0.40; P=0.02).
Funded by a grant from the National Institute of Neurological Disorders and Stroke, National Institutes of Health. Additional local support provided by several NIH-funded General Clinical Research Centers. Medications supplied by Bristol-Myers Squibb and Bayer, without direct funding.
Full details and results are available in The New England Journal of Medicine publication.