A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke

J. P. Mohr, J. L P Thompson, R. M. Lazar, B. Levin, Ralph L Sacco, K. L. Furie, J. P. Kistler, G. W. Albers, L. C. Pettigrew, H. P. Adams, C. M. Jackson, P. Pullicino

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Abstract

Background: Despite the use of antiplatelet agents, usually aspirin, in patients who have had an ischemic stroke, there is still a substantial rate of recurrence. Therefore, we investigated whether warfarin, which is effective and superior to aspirin in the prevention of cardiogenic embolism, would also prove superior in the prevention of recurrent ischemic stroke in patients with a prior noncardioembolic ischemic stroke. Methods: In a multicenter, double-blind, randomized trial, we compared the effect of warfarin (at a dose adjusted to produce an international normalized ratio of 1.4 to 2.8) and that of aspirin (325 mg per day) on the combined primary end point of recurrent ischemic stroke or death from any cause within two years. Results: The two randomized study groups were similar with respect to base-line risk factors. In the intention-to-treat analysis, no significant differences were found between the treatment groups in any of the outcomes measured. The primary end point of death or recurrent ischemic stroke was reached by 196 of 1103 patients assigned to warfarin (17.8 percent) and 176 of 1103 assigned to aspirin (16.0 percent; P = 0.25; hazard ratio comparing warfarin with aspirin, 1.13; 95 percent confidence interval, 0.92 to 1.38). The rates of major hemorrhage were low (2.22 per 100 paitent-years in the warfarin group and 1.49 per 100 patient-years in the aspirin group). Also, there were no significant treatment-related differences in the frequency of or time to the primary end point or major hemorrhage according to the cause of the initial stroke. Conclusions: Over a two-year period, we found no difference between aspirin and warfarin in the prevention of recurrent ischemic stroke or death or in the rate of major hemorrhage. Consequently, we regard both warfarin and aspirin as reasonable therapeutic alternatives.

Original languageEnglish
Pages (from-to)1444-1451
Number of pages8
JournalNew England Journal of Medicine
Volume345
Issue number20
DOIs
StatePublished - Nov 15 2001
Externally publishedYes

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Warfarin
Aspirin
Stroke
Hemorrhage
Intention to Treat Analysis
International Normalized Ratio
Platelet Aggregation Inhibitors
Embolism
Cause of Death
Therapeutics
Confidence Intervals
Recurrence

ASJC Scopus subject areas

  • Medicine(all)

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Mohr, J. P., Thompson, J. L. P., Lazar, R. M., Levin, B., Sacco, R. L., Furie, K. L., ... Pullicino, P. (2001). A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. New England Journal of Medicine, 345(20), 1444-1451. https://doi.org/10.1056/NEJMoa011258

A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. / Mohr, J. P.; Thompson, J. L P; Lazar, R. M.; Levin, B.; Sacco, Ralph L; Furie, K. L.; Kistler, J. P.; Albers, G. W.; Pettigrew, L. C.; Adams, H. P.; Jackson, C. M.; Pullicino, P.

In: New England Journal of Medicine, Vol. 345, No. 20, 15.11.2001, p. 1444-1451.

Research output: Contribution to journalArticle

Mohr, JP, Thompson, JLP, Lazar, RM, Levin, B, Sacco, RL, Furie, KL, Kistler, JP, Albers, GW, Pettigrew, LC, Adams, HP, Jackson, CM & Pullicino, P 2001, 'A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke', New England Journal of Medicine, vol. 345, no. 20, pp. 1444-1451. https://doi.org/10.1056/NEJMoa011258
Mohr, J. P. ; Thompson, J. L P ; Lazar, R. M. ; Levin, B. ; Sacco, Ralph L ; Furie, K. L. ; Kistler, J. P. ; Albers, G. W. ; Pettigrew, L. C. ; Adams, H. P. ; Jackson, C. M. ; Pullicino, P. / A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. In: New England Journal of Medicine. 2001 ; Vol. 345, No. 20. pp. 1444-1451.
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AU - Mohr, J. P.

AU - Thompson, J. L P

AU - Lazar, R. M.

AU - Levin, B.

AU - Sacco, Ralph L

AU - Furie, K. L.

AU - Kistler, J. P.

AU - Albers, G. W.

AU - Pettigrew, L. C.

AU - Adams, H. P.

AU - Jackson, C. M.

AU - Pullicino, P.

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N2 - Background: Despite the use of antiplatelet agents, usually aspirin, in patients who have had an ischemic stroke, there is still a substantial rate of recurrence. Therefore, we investigated whether warfarin, which is effective and superior to aspirin in the prevention of cardiogenic embolism, would also prove superior in the prevention of recurrent ischemic stroke in patients with a prior noncardioembolic ischemic stroke. Methods: In a multicenter, double-blind, randomized trial, we compared the effect of warfarin (at a dose adjusted to produce an international normalized ratio of 1.4 to 2.8) and that of aspirin (325 mg per day) on the combined primary end point of recurrent ischemic stroke or death from any cause within two years. Results: The two randomized study groups were similar with respect to base-line risk factors. In the intention-to-treat analysis, no significant differences were found between the treatment groups in any of the outcomes measured. The primary end point of death or recurrent ischemic stroke was reached by 196 of 1103 patients assigned to warfarin (17.8 percent) and 176 of 1103 assigned to aspirin (16.0 percent; P = 0.25; hazard ratio comparing warfarin with aspirin, 1.13; 95 percent confidence interval, 0.92 to 1.38). The rates of major hemorrhage were low (2.22 per 100 paitent-years in the warfarin group and 1.49 per 100 patient-years in the aspirin group). Also, there were no significant treatment-related differences in the frequency of or time to the primary end point or major hemorrhage according to the cause of the initial stroke. Conclusions: Over a two-year period, we found no difference between aspirin and warfarin in the prevention of recurrent ischemic stroke or death or in the rate of major hemorrhage. Consequently, we regard both warfarin and aspirin as reasonable therapeutic alternatives.

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