Effect of treatment on the incidence of stroke and other emboli in 519 patients with severe thoracic aortic plaque

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

“…However, observational studies among patients with a recent embolic event, including stroke or TIA, suggest that statins may be effective in preventing recurrent events. 582 Data on the utility of antiplatelet versus anticoagulant therapy for secondary prevention of atheroembolism are mixed; no randomized studies exist, and the remaining studies are small and confounded and do not reflect current medical management paradigms. [583][584][585][586] The SPAF III trial 583 evaluated the rate of ischemic stroke or systemic embolism in patients with nonvalvular AF randomly assigned to adjusted-dose warfarin therapy versus low-dose warfarin plus 325 mg of aspirin.…”

Predictors of Long-Term Mortality in Patients With Ischemic Stroke Referred for Transesophageal Echocardiography

“…24 In unselected patients found to have CAA on TEE, there is conflicting data on the protective benefit of warfarin therapy on prevention of combined vascular events. 17,23 Although future studies are needed to establish the effect of medical therapy on long-term mortality in ischemic stroke patients found to have CAA on TEE, our results clearly identify for the first time the independent mortality risk associated with aortic atheroma in this population. Thus, an aggressive approach to risk factor modification in these patients is appropriate.…”

“…Previous studies have demonstrated that statin therapy and warfarin therapy are associated with fewer recurrent embolic events and combined cardiovascular events. 17,23,24 Statins have been shown to be associated with fewer recurrent cardiovascular events in unselected TEE patients found to have CAA. 23 Although the number of patients with CAA on statin therapy in the present study was too small to confirm a treatment benefit, our findings are consistent with these observations and further support the treatment of stroke patients with statin therapy.…”

Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke

“…In smaller, nonrandomized studies, oral anticoagulants were superior to aspirin, 20,21 whereas in a larger retrospective, nonrandomized analysis, only statins showed a significant benefit. 22 The ongoing Aortic arch Related Cerebral Hazard (ARCH) trial comparing clopidogrel plus aspirin versus warfarin will contribute substantial information for the optimal treatment and might increase the diagnostic impact of TEE. Furthermore, knowledge of high-risk aortic atherosclerosis (ie, plaques Ն4 mm) will also lead to intensified treatment of cardiovascular risk factors in these patients.…”