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

https://doi.org/10.1136/ebm.10.5.136

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    Chimowitz MI, Lynn MJ, Howlett-Smith H, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005;352:1305–16.
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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 ★★★★★★☆

    METHODS

    Embedded ImageDesign:

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

    Embedded ImageAllocation:

    concealed.*

    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).

    MAIN RESULTS

    Aspirin and warfarin did not differ for …

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    Footnotes

    • ↵* See glossary.

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

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

    Linked Articles

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      BMJ Publishing Group Ltd
      BMJ Evidence-Based Medicine 2005; 10 160a-160a Published Online First: 30 Sep 2005. doi: 10.1136/ebm.10.5.160a