Warfarin versus aspirin in the secondary prevention of stroke: The WARSS study

Redman, Andrea R.; Allen, LaWanda C

doi:10.1007/s11883-002-0011-9

Cited by 8 publications

(2 citation statements)

References 19 publications

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“…There is no benefit to combining aspirin and warfarin therapy to prevent stroke. 40 Transient Ischemic Attack in the Acute Setting-Diagnosis, Management, and Treatment…”

Section: Antiplatelet and Anticoagulation Therapymentioning

confidence: 99%

Transient Ischemic Attack in the Acute Setting—Diagnosis, Management, and Treatment

Bhatt¹,

Glynn²,

Reeves³

2008

US Neurology

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More than 700,000 acute strokes 1 and 300,000 transient ischemic attacks (TIAs) 2,3 occur annually in the US. It is estimated that between 15 and 26% of acute stroke cases have a prior history of TIA. 4 TIAs are important because they are associated with high short-term risk for both stroke and cardiac events. In a widely quoted emergency department (ED) study of over 1,700 TIA cases from California, the three-month stroke risk was found to be 10.5%. 5 A recent meta-analysis of 11 TIA cohort studies found that the summary estimate for the 90-day stroke risk was 9.2%-very similar to the Californian study. 6 This meta-analysis also confirmed that most of this stroke risk occurs in the first few days after the TIA event; the risk for stroke was 3.5% at two days and 8.0% at 30 days. 6 Similar findings were found in another recent meta-analysis of 18 cohort studies, which estimated that the seven-day risk for stroke was 5.2%. 7 Patients with TIA are also at high risk for other cardiovascular events. In a meta-analysis of 39 cohort studies, the annual risk for myocardial infarction and non-stroke vascular death following TIA was 2.2 and 2.1%, respectively. 8 These studies, which serve to illustrate

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“…There is no benefit to combining aspirin and warfarin therapy to prevent stroke. 40 Transient Ischemic Attack in the Acute Setting-Diagnosis, Management, and Treatment…”

Section: Antiplatelet and Anticoagulation Therapymentioning

confidence: 99%

Transient Ischemic Attack in the Acute Setting—Diagnosis, Management, and Treatment

Bhatt¹,

Glynn²,

Reeves³

2008

US Neurology

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“…Warfarin in the WASID trial failed to show any benefit in patients with symptomatic IAS. Moreover, according to the Warfarin–Aspirin Recurrent Stroke Study (WARSS) (14, 15), which recruited 2206 patients, 149 patients (13·5%) in the warfarin arm developed recurrent ischaemic stroke, while 123 (11·2%) in the aspirin arm developed stroke at about 2·1 years of follow‐up. For large artery stroke, the primary events (death or recurrent ischaemic stroke) occurred more often in patients on warfarin (18·7%) than those on aspirin (15·6%).…”

Section: Medical Management Of Intracranial Atherosclerosismentioning

confidence: 99%

Management of Patients with Symptomatic Intracranial Atherosclerosis

Leung

Kwon

Wong

2006

International Journal of Stroke

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Intracranial atherosclerosis is a common cause of stroke, accounting for about 50% of ischaemic stroke in Asia and 8% in North America. Many prospective studies have confirmed that intracranial stenosis is an independent predictor for poor outcomes such as recurrent vascular event and death, despite the use of antiplatelet agents. The annual event rate is about 15% per year. The dismal outcome prompts the study of more aggressive treatment strategies, including warfarin and endovascular intervention. We have reviewed the published literature for the treatment of symptomatic intracranial stenosis. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial and Warfarin-Aspirin Recurrent Stroke Study (WARSS) studies failed to show that oral anticoagulation was better than aspirin in IAS. Initial encouraging results were found in the use of dual antiplatelet therapy in arresting the progression of stenosis. The results of the endovascular studies are mixed: there are more encouraging results with recent advances of technology in stent design, but a randomized controlled study is still lacking. Although there is still no established therapy for IAS, the results of ongoing randomized clinical trials to study dual antiplatelet agents and the use of endovascular intervention may soon provide clinicians with more evidence to better manage patients with this condition.

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