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Cited by 1,168Acute Ischemic Stroke ManagementAntiplatelet Therapy and Cardiovascular DiseasesAtrial Fibrillation Management and Outcomes

The DOI matches its Crossref record; 39 of the 39 references it cites were found in a registry or an index.

A Comparison of Warfarin and Aspirin for the Prevention of Recurrent Ischemic Stroke

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Mohr, J.P., Thompson, J.L.P., Lazar, R.M., Levin, B., Sacco, R.L., Furie, K.L., Kistler, J.P., Albers, G.W., Pettigrew, L.C., Adams, H.P., Jackson, C.M., Pullicino, P.·2001·New England Journal of Medicine
DOI 10.1056/nejmoa011258
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Abstract

BACKGROUND: Despite the use of antiplatelet agents, usually aspirin, in patients who have had an ischemic stroke, there is still a substantial rate of recurrence. Therefore, we investigated whether warfarin, which is effective and superior to aspirin in the prevention of cardiogenic embolism, would also prove superior in the prevention of recurrent ischemic stroke in patients with a prior noncardioembolic ischemic stroke. METHODS: In a multicenter, double-blind, randomized trial, we compared the effect of warfarin (at a dose adjusted to produce an international normalized ratio of 1.4 to 2.8) and that of aspirin (325 mg per day) on the combined primary end point of recurrent ischemic stroke or death from any cause within two years. RESULTS: The two randomized study groups were similar with respect to base-line risk factors. In the intention-to-treat analysis, no significant differences were found between the treatment groups in any of the outcomes measured. The primary end point of death or recurrent ischemic stroke was reached by 196 of 1103 patients assigned to warfarin (17.8 percent) and 176 of 1103 assigned to aspirin (16.0 percent; P=0.25; hazard ratio comparing warfarin with aspirin, 1.13; 95 percent confidence interval, 0.92 to 1.38). The rates of major hemorrhage were low (2.22 per 100 patient-years in the warfarin group and 1.49 per 100 patient-years in the aspirin group). Also, there were no significant treatment-related differences in the frequency of or time to the primary end point or major hemorrhage according to the cause of the initial stroke (1237 patients had had previous small-vessel or lacunar infarcts, 576 had had cryptogenic infarcts, and 259 had had infarcts designated as due to severe stenosis or occlusion of a large artery). CONCLUSIONS: Over two years, we found no difference between aspirin and warfarin in the prevention of recurrent ischemic stroke or death or in the rate of major hemorrhage. Consequently, we regard both warfarin and aspirin as reasonable therapeutic alternatives.

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  1. 1980, Lancet, 2, 989
  2. Thompson JLP, 1994, Ann Neurol, 36, 305
  3. 10.2307/2281868 · DOI · Paper page
  4. Mantel N, 1966, Cancer Chemother Rep, 50, 163

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Metadata

Authors
Mohr, J. P., Thompson, J. L. P., Lazar, R. M., Levin, B., Sacco, R. L., Furie, K. L., Kistler, J. P., Albers, G. W., Pettigrew, L. C., Adams, H. P., Jackson, C. M., & Pullicino, P.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Massachusetts General Hospital (US)
  • Stanford Medicine (US)
  • University of Kentucky (US)
  • University of California San Diego (US)
  • University at Buffalo, State University of New York (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2001-11-15
Volume
345
Issue
20
Pages
1444-1451
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa011258
OpenAlex
W2027538725
Cited by
1,168
References
39
Citations by year
2026: 9 · 2025: 12 · 2024: 13 · 2023: 22 · 2022: 20 · 2021: 40 · 2020: 24 · 2019: 37 · 2018: 32 · 2017: 33 · 2016: 50 · 2015: 41 · 2014: 54 · 2013: 39 · 2012: 49
FWCI
54.22
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Kent Academic Repository (University of Kent) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Yale University
  • University of Southern California
  • Vanderbilt University
  • University of Miami
  • Wayne State University
  • Cleveland Clinic
  • Cleveland Clinic Foundation
  • Johns Hopkins University
  • Hennepin County Medical Center
  • University of South Alabama
  • York University
  • University of Illinois at Urbana-Champaign
  • National Institute of Neurological Disorders and Stroke (R01NS028371)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Keywords
warfarin, aspirin, recurrent ischemic stroke, secondary stroke prevention, antiplatelet therapy, major bleeding, non-cardioembolic stroke, lacunar infarction, cryptogenic stroke, international normalized ratio, anticoagulation
MeSH terms
Adult, Aged, Aged, 80 and over, Anticoagulants, Aspirin, Brain Ischemia, Double-Blind Method, Female, Hemorrhage, Humans, Male, Middle Aged, Mortality, Platelet Aggregation Inhibitors, Risk Factors, Warfarin, International Normalized Ratio, Stroke, Secondary Prevention

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