Study: Aspirin is better choice

Neurologists are split on whether taking the drug warfarin is worth the risk.
SCRIPPS HOWARD NEWS SERVICE
Patients at risk of stroke from narrowed brain arteries should take aspirin rather than the common anti-clotting drug warfarin, a major new study concludes.
The condition, called intracranial stenosis, is caused by the same hardening of the arteries, or buildup of fatty deposits along artery walls, that causes heart attacks. It is responsible for about 10 percent of the more than 900,000 strokes and transient (mini) strokes Americans suffer each year.
Those who suffer a stroke due to such narrowing have a much greater risk of having a second stroke, about 15 percent a year. Studies in the 1950s suggested that anti-clotting drugs such as warfarin could reduce the risk in such patients.
Doubts
But over the past several decades, doubts about warfarin's safety and side effects as well as smaller studies on aspirin's effectiveness have cast enough doubt on the drug that a recent survey of neurologists found them split 50-50 on which treatment they used on patients with intracranial disease.
"Our goal was to answer this question which has been asked for 20 years: Is warfarin more effective than aspirin?" said Dr. Marc Chimowitz, a professor of neurology at Emory University's School of Medicine and lead author of the study, published today in the New England Journal of Medicine.
The $15 million study was cut off early -- after just 569 patients, rather than the planned 800, were randomly assigned to one of the treatments at 59 U.S. medical centers -- because researchers were concerned about the safety of those getting warfarin. The drug is sold under the brand name Coumadin.
All the patients had a major brain artery that was blocked more than 50 percent and had suffered a transient stroke or a nondisabling stroke within 90 days of enrolling in the study.