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

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Abstract

The role of anticoagulation in the secondary prevention of noncardioembolic stroke has long been an area of debate. Previous evidence has shown that anticoagulation is unsafe at an International Normalized Ratio between 3.0 and 4.5. Results of the recently published Warfarin-Aspirin Recurrent Stroke Study (WARSS) suggest that there is no difference between warfarin and aspirin in the prevention of recurrent ischemic stroke or death or in the rate of major hemorrhage. Differences in the therapeutic interventions used may have had an effect on the differences in endpoints achieved as compared with previous studies. Results of ongoing trials are anticipated to further clarify the role of anticoagulation in the secondary prevention of stroke.

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References and Recommended Reading

  1. American Heart Association: 2002 Heart and Stroke Statistical Update. Dallas, Texas: American Heart Association; 2001.

    Google Scholar 

  2. Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P: Antithrombotic and thrombolytic therapy for ischemic stroke. Chest 2001, 119:300S-320S.

    Article  PubMed  CAS  Google Scholar 

  3. The Stroke Prevention in Reversible Ischemia Trial (SPIRIT) Study Group: A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin. Ann Neurol 1997, 42:857–865.

    Article  Google Scholar 

  4. Mohr JP, Thompson JL, Lazar RM, et al.: A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001, 345:1444–1451.

    Article  PubMed  CAS  Google Scholar 

  5. The WARSS, APASS, PICSS, HAS, and GENESIS Study Groups: The feasibility of a collaborative double-blind study using an anticoagulant. Cerebrovasc Dis 1997, 7:100–112.

    Google Scholar 

  6. Brey RL, Levine SR, Thompson JL, et al.: Baseline frequencies, isotypes, and titers of antiphospholipid antibodies in the warfarin aspirin recurrent stroke study/antiphospholipid antibody stroke study (WARSS/APASS) collaboration: preliminary results. Stroke 2000, 31:280.

    Google Scholar 

  7. European/Australian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT). Accessible at http://home.wxs.nl/esprit/. Accessed January 30, 2002.

  8. Major ongoing stroke trials.Stroke 2001, 32:2448–2457.

  9. Loeliger EA: Therapeutic target range values in oral anticoagulation—justification of Dutch policy and a warning against the so-called moderate-intensity regimens. Ann Hematol 1992, 64:60–65.

    Article  PubMed  CAS  Google Scholar 

  10. Azar AJ, Cannegieter SC, Deckers JW, et al.: Optimal intensity of oral anticoagulant therapy after myocardial infarction. J Am Coll Cardiol 1996, 27:1349–1355.

    Article  PubMed  CAS  Google Scholar 

  11. Cannegieter SC, Rosendaal FR, Wintzen AR, et al.: Optimal oral anticoagulant therapy in patients with mechanical heart valves. N Engl J Med 1995, 333:11–17.

    Article  PubMed  CAS  Google Scholar 

  12. Hirsh J, Deykin D, Poller L: “Therapeutic range” for oral anticoagulant therapy. Chest 1986, 89:11S-15S.

    PubMed  CAS  Google Scholar 

  13. Hirsh J, Dalen JE, Anderson DR, et al.: Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 2001, 119:8S-21S.

    Article  PubMed  CAS  Google Scholar 

  14. The European Atrial Fibrillation Trial Study Group: Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. N Engl J Med 1995, 333:5–10.

    Article  Google Scholar 

  15. Stroke Prevention in Atrial Fibrillation Investigators: Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial. Lancet 1996, 348:633–638.

    Article  Google Scholar 

  16. Hylek EM, Skates SJ, Sheehan MA, Singer DE: An analysis of the lowest effective intensity of prophylactic anticoagulation for patients wtih nonrheumatic atrial fibrillation. N Engl J Med 1996, 335:540–546.

    Article  PubMed  CAS  Google Scholar 

  17. EAFT (European Atrial Fibrillation Trial) Study Group: Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993, 342:1255–1262.

    Google Scholar 

  18. Hylek EM, Singer DE: Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 1994, 120:897–902.

    PubMed  CAS  Google Scholar 

  19. Albers GW, Hart RG, Lutsep HL, Newell DW, Sacco RL: AHA Scientific Statement: supplement to the guidelines for the management of transient ischemic attacks. Stroke 1999, 30:2502–2511.

    PubMed  CAS  Google Scholar 

  20. Dutch TIA Trial Study Group: A comparison of two doses of aspirin (30 mg vs 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke. N Engl J Med 1991, 325:1261–1266.

    Article  Google Scholar 

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Redman, A.R., Allen, L.C. Warfarin versus aspirin in the secondary prevention of stroke: The WARSS study. Curr Atheroscler Rep 4, 312–318 (2002). https://doi.org/10.1007/s11883-002-0011-9

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  • DOI: https://doi.org/10.1007/s11883-002-0011-9

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