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Warfarin was not more effective than aspirin and increased adverse events in symptomatic intracranial arterial stenosis

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 Q In patients with symptomatic intracranial arterial stenosis, how does aspirin compare with warfarin?

Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★★☆ Neurology ★★★★★★★ Cardiology ★★★★★★☆


Embedded ImageDesign:

randomised controlled trial (Warfarin-Aspirin Symptomatic Intracranial Disease [WASID] Trial).

Embedded ImageAllocation:


Embedded ImageBlinding:

blinded (patients and outcome assessors).*

Embedded ImageFollow up period:

mean 1.8 years.

Embedded ImageSetting:

59 sites in North America.

Embedded ImagePatients:

569 patients ⩾40 years of age (mean age 64 y, 61.5% men) with transient ischaemic attack or non-disabling stroke in the previous 90 days caused by 50–99% stenosis of a major intracranial artery and a modified Rankin score ⩽3. Exclusion criteria included tandem 50–99% stenosis of the extracranial carotid artery, non-atherosclerotic stenosis of an intracranial artery, and a cardiac source of embolism.

Embedded ImageIntervention:

aspirin, 1300 mg/day (n = 280), or warfarin, 5 mg/day initial dose, which was adjusted to achieve an international normalised ratio (INR) of 2.0–3.0 (n = 289).

Embedded ImageOutcomes:

primary composite endpoint of ischaemic stroke, brain hemorrhage, and death from vascular causes other than stroke; and adverse events.

Embedded ImagePatient follow up:

98% (intention to treat analysis).


Aspirin and warfarin did not differ for …

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  • * See glossary.

  • For correspondence: Dr M I Chimowitz, Emory University, Atlanta, GA, USA.

  • Sources of funding: National Institutes of Health; Bristol-Myers Squibb; Bayer.

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