Antiplatelets Recommended for Prevention of Recurrent Stroke or Death

Results of the Warfarin-Aspirin Recurrent Stroke Study published in the journal “Cerebrovascular Diseases” show no benefit of warfarin over aspirin for the prevention of recurrent stroke or death. Therefore, pending future clinical trial evidence to the contrary, antiplatelets are recommended for survivors of noncardioembolic stroke.

The efficacy of adjusted-dose warfarin to aspirin for recurrent ischemic stroke or death within 2 years was compared among prespecified and exploratory subgroups with respect to sociodemographic and vascular risk factors, stroke subtype, arterial territory, and infarct topography. Hazard ratios and 95% confidence intervals comparing warfarin to aspirin were calculated using Cox proportional hazards models. Differences in hazard ratios were tested using interaction terms.

No treatment differences between warfarin and aspirin were found across multiple prespecified subgroups. In a multivariate model, warfarin was associated with a greater hazard among patients with moderate stroke severity and a greater benefit among those with posterior circulation location without brainstem infarction. In post-hoc analyses of the cryptogenic subgroup, warfarin was associated with worse outcomes among patients with moderate stroke severity and better outcomes among those without baseline hypertension or with posterior circulation infarcts sparing the brainstem