Effect of aspirin and warfarin therapy in stroke patients with valvular strands

Shunichi Homma, Marco R. Di Tullio, Robert R. Sciacca, Ralph L Sacco, J. P. Mohr

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background-Valvular strands are associated with ischemic stroke. The recurrent rate of adverse events in stroke patients with valvular strands has not been defined and, importantly, there are no randomized studies to evaluate efficacy of antithrombotic therapies in these patients. Methods-Patent Foramen Ovale in Cryptogenic Stroke Study (PICSS) enrolled 630 stroke patients, of whom 312 (49.5%) were randomized to warfarin and 318 (50.5%) were randomized to aspirin; 265 patients experienced cryptogenic stroke and 365 experienced stroke with known subtypes. Endpoints were recurrent ischemic stroke or death from any cause. All transesophageal echocardiography studies were blindly, centrally analyzed and all endpoints were blindly adjudicated. Results-Overall, of 619 studies analyzed, valvular strands were present in 39.4% of the patients (244/619), 5.8% (36/619) on the aortic valve and 27.8% (172/619) on the mitral valve, and 5.8% (36/619) on both valves. In an intention-to-treat analysis, there was no significant difference in the time to primary endpoints between patients with and without strands in the overall population (P=0.82; hazard ratio: 1.05; 95% CI: 0.70 to 1.57; 2-year event rates: 16.4% versus 15.5%). Among the patients with strands, there was no significant difference in the time to primary endpoints between those treated with warfarin or aspirin (P=0.21; hazard ratio: 0.67; 95% CI: 0.36 to 1.26; 2-year event rates: 13.5% versus 19.6%). Conclusions-While on medical therapy, valvular strands do not significantly increase recurrent adverse event rates in patients with ischemic stroke. Furthermore, the study does not provide evidence to support an advantage of warfarin or aspirin for this purpose.

Original languageEnglish
Pages (from-to)1436-1442
Number of pages7
JournalStroke
Volume35
Issue number6
DOIs
StatePublished - Jun 1 2004
Externally publishedYes

Fingerprint

Warfarin
Aspirin
Stroke
Therapeutics
Patent Foramen Ovale
Intention to Treat Analysis
Transesophageal Echocardiography
Aortic Valve
Mitral Valve
Cause of Death
Population

Keywords

  • Aortic valve
  • Echocardiography
  • Epidemiology
  • Mitral valve
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Effect of aspirin and warfarin therapy in stroke patients with valvular strands. / Homma, Shunichi; Di Tullio, Marco R.; Sciacca, Robert R.; Sacco, Ralph L; Mohr, J. P.

In: Stroke, Vol. 35, No. 6, 01.06.2004, p. 1436-1442.

Research output: Contribution to journalArticle

Homma, Shunichi ; Di Tullio, Marco R. ; Sciacca, Robert R. ; Sacco, Ralph L ; Mohr, J. P. / Effect of aspirin and warfarin therapy in stroke patients with valvular strands. In: Stroke. 2004 ; Vol. 35, No. 6. pp. 1436-1442.
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abstract = "Background-Valvular strands are associated with ischemic stroke. The recurrent rate of adverse events in stroke patients with valvular strands has not been defined and, importantly, there are no randomized studies to evaluate efficacy of antithrombotic therapies in these patients. Methods-Patent Foramen Ovale in Cryptogenic Stroke Study (PICSS) enrolled 630 stroke patients, of whom 312 (49.5{\%}) were randomized to warfarin and 318 (50.5{\%}) were randomized to aspirin; 265 patients experienced cryptogenic stroke and 365 experienced stroke with known subtypes. Endpoints were recurrent ischemic stroke or death from any cause. All transesophageal echocardiography studies were blindly, centrally analyzed and all endpoints were blindly adjudicated. Results-Overall, of 619 studies analyzed, valvular strands were present in 39.4{\%} of the patients (244/619), 5.8{\%} (36/619) on the aortic valve and 27.8{\%} (172/619) on the mitral valve, and 5.8{\%} (36/619) on both valves. In an intention-to-treat analysis, there was no significant difference in the time to primary endpoints between patients with and without strands in the overall population (P=0.82; hazard ratio: 1.05; 95{\%} CI: 0.70 to 1.57; 2-year event rates: 16.4{\%} versus 15.5{\%}). Among the patients with strands, there was no significant difference in the time to primary endpoints between those treated with warfarin or aspirin (P=0.21; hazard ratio: 0.67; 95{\%} CI: 0.36 to 1.26; 2-year event rates: 13.5{\%} versus 19.6{\%}). Conclusions-While on medical therapy, valvular strands do not significantly increase recurrent adverse event rates in patients with ischemic stroke. Furthermore, the study does not provide evidence to support an advantage of warfarin or aspirin for this purpose.",
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AU - Homma, Shunichi

AU - Di Tullio, Marco R.

AU - Sciacca, Robert R.

AU - Sacco, Ralph L

AU - Mohr, J. P.

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N2 - Background-Valvular strands are associated with ischemic stroke. The recurrent rate of adverse events in stroke patients with valvular strands has not been defined and, importantly, there are no randomized studies to evaluate efficacy of antithrombotic therapies in these patients. Methods-Patent Foramen Ovale in Cryptogenic Stroke Study (PICSS) enrolled 630 stroke patients, of whom 312 (49.5%) were randomized to warfarin and 318 (50.5%) were randomized to aspirin; 265 patients experienced cryptogenic stroke and 365 experienced stroke with known subtypes. Endpoints were recurrent ischemic stroke or death from any cause. All transesophageal echocardiography studies were blindly, centrally analyzed and all endpoints were blindly adjudicated. Results-Overall, of 619 studies analyzed, valvular strands were present in 39.4% of the patients (244/619), 5.8% (36/619) on the aortic valve and 27.8% (172/619) on the mitral valve, and 5.8% (36/619) on both valves. In an intention-to-treat analysis, there was no significant difference in the time to primary endpoints between patients with and without strands in the overall population (P=0.82; hazard ratio: 1.05; 95% CI: 0.70 to 1.57; 2-year event rates: 16.4% versus 15.5%). Among the patients with strands, there was no significant difference in the time to primary endpoints between those treated with warfarin or aspirin (P=0.21; hazard ratio: 0.67; 95% CI: 0.36 to 1.26; 2-year event rates: 13.5% versus 19.6%). Conclusions-While on medical therapy, valvular strands do not significantly increase recurrent adverse event rates in patients with ischemic stroke. Furthermore, the study does not provide evidence to support an advantage of warfarin or aspirin for this purpose.

AB - Background-Valvular strands are associated with ischemic stroke. The recurrent rate of adverse events in stroke patients with valvular strands has not been defined and, importantly, there are no randomized studies to evaluate efficacy of antithrombotic therapies in these patients. Methods-Patent Foramen Ovale in Cryptogenic Stroke Study (PICSS) enrolled 630 stroke patients, of whom 312 (49.5%) were randomized to warfarin and 318 (50.5%) were randomized to aspirin; 265 patients experienced cryptogenic stroke and 365 experienced stroke with known subtypes. Endpoints were recurrent ischemic stroke or death from any cause. All transesophageal echocardiography studies were blindly, centrally analyzed and all endpoints were blindly adjudicated. Results-Overall, of 619 studies analyzed, valvular strands were present in 39.4% of the patients (244/619), 5.8% (36/619) on the aortic valve and 27.8% (172/619) on the mitral valve, and 5.8% (36/619) on both valves. In an intention-to-treat analysis, there was no significant difference in the time to primary endpoints between patients with and without strands in the overall population (P=0.82; hazard ratio: 1.05; 95% CI: 0.70 to 1.57; 2-year event rates: 16.4% versus 15.5%). Among the patients with strands, there was no significant difference in the time to primary endpoints between those treated with warfarin or aspirin (P=0.21; hazard ratio: 0.67; 95% CI: 0.36 to 1.26; 2-year event rates: 13.5% versus 19.6%). Conclusions-While on medical therapy, valvular strands do not significantly increase recurrent adverse event rates in patients with ischemic stroke. Furthermore, the study does not provide evidence to support an advantage of warfarin or aspirin for this purpose.

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KW - Echocardiography

KW - Epidemiology

KW - Mitral valve

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