Trial of long-term anticoagulant therapy in the treatment of small stroke associated with a normal carotid arteriogram.

Bradshaw, Peter; Brennan, Stephen O.

doi:10.1136/jnnp.38.7.642

Cited by 19 publications

(6 citation statements)

References 16 publications

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“…However, this was not confirmed by Bradshaw and Brennan. 36 Even if the effect of anticoagulant treatment -reducing the frequency of TIA/TIA-IR and preventing completed strokes -is accepted, some hesitate to use the treatment because of the risk of complications, especially the risk of intracranial hemorrhage, which sometimes occurs in treated patients. 3 ' 27> 37 In our material, no patient died of bleeding complication, but nine (5.1%) had such severe complications that the treatment had to be withdrawn.…”

Section: Discussionmentioning

confidence: 99%

Long-term anticoagulant therapy for TIAs and minor strokes with minimum residuum.

Olsson¹,

Müller²,

Berneli³

1976

Stroke

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One hundred seventy-eight patients with transient ischemic attacks (TIAs) or small strokes with slight symptoms persisting for more than 24 hours (incomplete recovery = IR) (TIA-IR) from both the carotid and the vertebrobasilar systems were treated with anticoagulants. Ten patients stopped the treatment because of severe side effects. Only one patient had a lethal cerebral infarction when the thrombotest values were above the therapeutic level; no other infarction happened during the treatment period. Moreover, the frequency of TIA decreased during the treatment, compared with descriptions of the natural course of TIA. One hundred four patients were observed for a mean of 21 months after the anticoagulant treatment ended. During the observation period, six patients had cerebral infarctions. This was a sixfold increase compared with the stroke incidence during treatment, and was almost identical with the incidence of strokes seen during the natural course of TIA. All the cerebral infarctions were in patients who had their initial TIA/TIA-IR from the carotid territory (within the same carotid artery which earlier had given symptoms). The investigation shows that long-term anticoagulant treatment is useful, especially in patients with carotid TIA/TIA-IR, and that this treatment should continue as long as the patients can manage it. In patients with vertebrobasilar symptoms of malignant character, it seems feasible to terminate the treatment after about one year. The mechanism of the anticoagulant treatment is obscure, but it does not appear to influence the progress of the atherosclerotic process.

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Section: Discussionmentioning

confidence: 99%

Long-term anticoagulant therapy for TIAs and minor strokes with minimum residuum.

Olsson¹,

Müller²,

Berneli³

1976

Stroke

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“…Outcome was slightly worse among 43 treated women than among 39 control women (p>0.05). Table 2 also summarizes outcome by type and stability of ischemic event: TIA; TIA or minor stroke (the minor stroke cases of Bradshaw and Brennan 16 cannot be separated from their TIA cases); embolism; stable stroke; and all strokes thrombotic 5 Baker et al, 6 Hill et al, 7 -8 National Cooperative Study, 910 Veterans Administration Cooperative Study," Enger and Boyesen, 14 Pearce et al, 15 Bradshaw and Brennan. 16 Studies begun in 1974 or later: Buren and Ygge, 17 Olsson et al, 18 Garde et al, 19 Cerebral Embolism Study, 20 Duke et al 21 ACT, anticoagulant therapy; C, control; <, worse than; >, better than; NS, difference not significant.…”

Section: Pooled Resultsmentioning

confidence: 99%

Anticoagulant therapy in cerebrovascular disease: review and meta-analysis.

Jonas

1988

Stroke

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Sixteen acceptably randomized studies of anticoagulant therapy after cerebral or retinal ischemia or infarction are reviewed and the results among 1,046 anticoagulated patients and 1,071 controls are analyzed. The following conclusions are derived. 1) Anticoagulant therapy has not been shown to be better than control management after transient ischemia or nonprogressing ischemic stroke; this is true whether the control management was deliberately ineffectual treatment (generally studies completed in 1974 or earlier) or platelet antiaggregant therapy (pooled results of three recent studies). 2) Although a study done 30 years ago demonstrated no benefit, a recent study showed benefit from anticoagulant therapy in patients who had had cerebral emboli of cardiac origin; additional controlled data are needed. 3) There is evidence that patients with thrombosis in evolution might benefit from anticoagulant therapy; additional controlled data are needed. (Table 1). Materials and MethodsStudies were found through computerized search, direct search of the cumulative Index Medicus, suggestions from colleagues, and review of references in articles already discovered. Being well aware that an analysis such as this, especially when the work of one person, can suffer from error, incompleteness, and bias, 22 I solicit references to studies I have missed and alternative interpretations of the data I have summarized. I will, on request, provide more extensive notes on my own interpretations, as well as the various calculations.Where possible, I have used the end points of stroke or death (S + D) occurring during observation. The overall expected S + D per patient-month of observation for a given (arm of a) study is the sum of S + D for the treated and control groups divided by the sum of the patient-months for the two groups. This overall expected S + D rate multiplied by the patient-months of observation for each group separately gives the expected S + D for each group. Significance is defined as /?<0.05. Where feasible, I have pooled the S + D results for meta-analysis. Certain studies present results in forms not suitable for S + D analysis and are therefore not amenable to meta-analytic pooling; the authors' end points are given for these studies and the authors' analyses of significance are recorded. Table 2 summarizes the S + D results from 10 studies in which patients with stroke and transient ischemic attacks (TIAs) were randomized to ACT or to deliberately ineffectual treatment (placebo, no treatment, or deliberately ineffectual doses of anticoagulants). Among 20 identifiable groups or subgroups from these 10 studies there is one (the Cerebral Embolism Study 20 ) in which the ACT outcome was significantly better than control. In three other instances (the completed stroke and embolism groups from the National Cooperative Study 910 and the male stroke group from the Veterans Administration Cooperative Study") the ACT results were significantly worse than control. In the other 16 groups or subgroups the difference between...

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“…Of the 19 studies, seven were excluded because of failure to address the appropriate clinical question, lack of randomization, or because interventions were given for less than 3 months. [28][29][30][31][32][33][34] Twelve studies (n = 6310 patients) met the inclusion criteria (Appendix). 13,[15][16][17][18][19][20][21][24][25][26][27] The mean age of patients was 63.1 (SD ± 3.57) years.…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen studies were selected for in-depth review. 13,[15][16][17][18][19][20][21][24][25][26][27][28][29][30][31][32][33][34] This list was circulated among experts in the field in an effort to identify missed studies. Our experts were not able to suggest additional relevant studies.…”

Section: Resultsmentioning

confidence: 99%