Preventing Stroke: The Choice Between Aspirin And Warfarin

of adult aspirin and were evaluated for an average of 2 years to see if they had a stroke or developed a systemic embolism, a clot causing sudden blockage of arterial blood supply to a limb or body organ (blood clots are the cause of 80 percent of all strokes). Investigators found that the rate of ischemic stroke or embolism among these patients was 2.2 percent a year, only slightly higher than the 1 percent rate experienced by the general population in this age range. However, for patients with hypertension, but none of the four other risk factors, the rate of strokes or embolism was significantly higher -- 3.6 percent. The rate of disabling stroke, however, was low in both groups.

The researchers concluded that, while hypertension in atrial fibrillation patients is a significant predictor of stroke, it remains to be seen whether these patients should take aspirin or warfarin. The final treatment decision should be made between the physician and the patient after considering the individual's risk for stroke, benefits from treatment, and personal preferences.

Higher-risk patients, who have one or more specified risk factors, suffer strokes at a rate of 8 percent a year, and through previous SPAF studies have been shown to benefit greatly from treatment with warfarin.

The study estimates that for every 1,000 atrial fibrillation patients in the low risk category, about five ischemic strokes would be prevented among those taking aspirin and three major hemorrhages would occur. If these same patients were given warfarin instead of aspirin over a 1-year period, about 10 ischemic strokes would be prevented, but the treatment might cause 10 to 12 major hemorrhages.

"When someone is prescribed warfarin for stroke prevention, it often means a 20-year commitment to taking the drug, and the risk of bleeding goes up every year you're on it," said Dr. Sherman. "For this reason, we have been eager to find exactly which patients will do well on aspirin therap

Contact: Margo Warren
301/ 496-5751
NIH/National Institute of Neurological Disorders and Stroke

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