"Warfarin vs. Aspirin in Patients with Recurrent Ischemic Stroke".The New England Journal of Medicine. 2001. 345(20):1444-1451.
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 Outcome 8.2 Secondary Outcomes 9 Criticisms 10 Funding 11 Further Reading
In patients with prior noncardioembolic ischemic stroke, is warfarin superior to aspirin in preventing recurrent ischemic stroke or death?
In patients with prior noncardioembolic ischemic stroke, warfarin was not superior to aspirin in preventing recurrent ischemic stroke or death and both were considered reasonable therapeutic alternatives.
The Warfarin–Aspirin Recurrent Stroke Study (WARSS) compared the efficacy of warfarin and aspirin for the prevention of recurrent ischemic stroke or death in patients with a history of noncardioembolic ischemic stroke. The trial found no significant difference between the two treatments over a two-year period, presenting both as viable options for secondary stroke prevention.
As of 2001, guidelines have not been updated to reflect the results of this trial.
- Multicenter, double-blind, randomized trial - N=2,206 patients with recent ischemic stroke - Warfarin (target INR 1.4 to 2.8) - Aspirin (325 mg per day) - Enrollment: 1993-2000 - Mean follow-up: 2 years - Analysis: Intention-to-treat - Primary outcome: Composite of recurrent ischemic stroke or death from any cause within two years
Inclusion Criteria - Age 30-85 years - Acceptable candidates for warfarin therapy - Had an ischemic stroke within the previous 30 days - Glasgow Outcome Scale score of 3 or higher
Exclusion Criteria - Baseline INR >1.4 - Stroke due to high-grade carotid stenosis planned for surgery - Stroke associated with inferred cardioembolic source, e.g., atrial fibrillation
Baseline Characteristics - Similar between both treatment groups
- Warfarin dose adjusted to maintain an INR 1.4 to 2.8 - Aspirin 325 mg daily
Primary Outcome - No significant difference in the rate of recurrent ischemic stroke or death between warfarin and aspirin (17.8% with warfarin vs. 16.0% with aspirin, P=0.25)
- Rates of major hemorrhage were low and not significantly different between treatment groups - Minor hemorrhages were more frequent in the warfarin group
- The study did not have sufficient power to show differences in treatment effects among various clinically identified stroke subtypes.
Supported by a grant from the National Institute of Neurological Disorders and Stroke. Medications and placebos were supplied by Dupont Pharmaceuticals and Bayer.
The original publication and accompanying editorial in "The New England Journal of Medicine" are suggested for further reading.