The Pharmaceutical Journal Vol 267 No 7175 p733-738
24 November 2001

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Aspirin effective as warfarin for stroke prevention

Aspirin is as effective as warfarin in preventing recurrent strokes in most patients, researchers say.

Dr Jay Mohr, neurological institute, Columbia Presbyterian Medical Centre, New York, and colleagues compared the effects of warfarin and aspirin in 2,206 patients. The dose of warfarin was adjusted to produce an international normalised ratio of between 1.4 and 2.8. Aspirin was given at a dose of 325mg a day. Patients were followed up for two years.

The researchers found no significant difference between the groups in the time to the primary endpoint of death or recurrent ischaemic stroke. This endpoint was reached by 17.8 per cent of the warfarin group and 16.0 per cent of the aspirin group. Rates of major haemorrhage were low, with no significant differences between the groups. However, patients in the warfarin group had more minor haemorrhages than those in the aspirin group.

The study follows an earlier trial that demonstrated that warfarin is more effective than aspirin in the prevention of recurrent strokes among patients with atrial fibrillation. The study by Dr Mohr et al provides evidence for patients without atrial fibrillation. They comment: "In our trial, warfarin was not superior to aspirin. If anything, the reverse was true; warfarin did not decrease the rate of severe recurrent stroke, as it does in patients with prior stroke associated with atrial fibrillation. Moreover, warfarin costs more than aspirin and requires more monitoring."

The study is published in The New England Journal of Medicine (2001;345:1444).

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