Aspirin more effective than warfarin for some patients

A new clinical trial concludes that aspirin is the preferred treatment for intracranial stenosis, although warfarin is still the top choice for certain stroke-related conditions.

By Susan J. Landers, AMNews staff. April 18, 2005.

Washington -- A new study comparing treatments to reduce the risk of stroke due to blockage of the brain's arteries may tip the balance toward using aspirin and away from the more expensive and complex warfarin regimen.

Results of a double-blind, randomized clinical trial published in the March 31 New England Journal of Medicine found that aspirin is safer than warfarin and just as effective for treating intracranial stenosis.

"The trial is good news. A simple, low-cost drug works just as well as one that requires complicated and expensive monitoring and dose adjustments," said John R. Marler, MD, the associate director for clinical trials at the National Institute of Neurological Disorders and Stroke, which funded the study.

Intracranial stenosis causes about 10% of the 900,000 strokes and transient ischemic attacks that occur in the United States each year. People who have a stroke or a TIA due to this condition, which is particularly common among blacks and Asians, also have an increased risk of a second stroke -- as great as 15% each year after the first incident occurs.

The trial came at a good time, said lead author Dr. Marc I. Chimowitz, a professor of neurology at Emory University School of Medicine in Atlanta. About 50% of the neurologists in the country use warfarin, or coumadin, and 50% use aspirin, he said. "No one really knew what the right answer was."

Plus the finding actually runs counter to that of a pilot study that found warfarin was the preferred treatment, he added.