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NEW YORK, NY. People who have had an ischemic stroke are routinely prescribed 325 mg of aspirin to
prevent a second stroke. Despite this intervention there is still an unacceptably high rate of recurrence.
Researchers at 48 American academic medical centers have just reported the results of a clinical trial
designed to determine if warfarin (Coumadin) would be more effective than aspirin. The trial involved 2206
stroke patients who had suffered an ischemic stroke within the previous 30 days. Patients whose stroke
was due to surgery or atrial fibrillation were excluded from the trial. Half the participants were assigned to
receive 325 mg aspirin daily for the two-year duration of the trial. The other 1103 patients received 2 mg
warfarin daily with the dose being adjusted as required to maintain an international normalized ratio (INR) of
1.4 to 2.8.
At the end of the two-year period 196 (17.8%) of the patients in the warfarin group had either died or
suffered a second stroke. In the aspirin group 176 (16.0%) of the patients had died or suffered a second
stroke. The incidence of major hemorrhage was similar with a rate of 2.22 per 100 patient-years in the
warfarin group and a rate of 1.49 per 100 patient-years in the aspirin group. Patients in the warfarin group
had significantly more minor bleeding events (20.8 per 100 patient-years) than did patients in the aspirin
group (12.9 per 100 patient-years). The researchers conclude that warfarin is not superior to aspirin for
prevention of a second stroke in the patient population studied.
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