A randomized trial showed that Aspirin is safer than Warfarin for stroke prevention in patients with intracranial arterial stenosis.

Intracranial stenosis is caused by atherosclerosis.
It causes about 10 percent of the 900,000 strokes and transient ischemic attacks ( TIAs ) in the United States each year.

In the study, called the Warfarin Aspirin Symptomatic Intracranial Disease ( WASID ) trial, investigators at 59 medical centers across the United States compared Warfarin ( target international normalized ratio, 2.0 to 3.0 ) to 1300 mg per day of Aspirin in 569 patients for an average of 1.8 years.

All of the patients had a greater than 50 percent stenosis of a major intracranial artery and had experienced a TIA or non-disabling stroke within the 90 days prior to their enrollment in the study.

The primary end point was ischemic stroke, brain hemorrhage or death from vascular causes.

The investigators found that about 22 percent of the patients had a subsequent ischemic stroke, brain hemorrhage, or death from other blood vessel-related causes, regardless of whether they received Aspirin or Warfarin.

However, the rates of major hemorrhage and death from all causes were significantly higher in the patients treated with Warfarin ( event rates for Aspirin compared to Warfarin, respectively, were 3.2 percent vs. 8.3 percent for major hemorrhage and 4.3 percent vs. 9.7 percent for death ).

Enrollment in the study was terminated earlier than originally planned on the recommendation of an independent Data and Safety Monitoring Board because of concern for the safety of the patients given Warfarin.

This clinical trial showed that Warfarin was associated with higher rates of adverse events than Aspirin.
Aspirin should be preferred to Warfarin in patients with intracranial arterial stenosis .

The study was funded by the National Institute of Neurological Disorders and Stroke ( NINDS ), part of the National Institutes of Health ( NIH ).

Source: The New England Journal of Medicine, 2005


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