The use of anticoagulants for secondary prevention following non-cardioembolic ischemic stroke is controversial. This systematic review evaluates the safety and efficacy of oral anticoagulation compared with control and antiplatelet therapy.
1 American Heart Association. Heart disease and stroke statistics – 2006 update.American Heart Association, 2006.
2.
2 O’Rourke FDean NAkhtar NShuaib A. Current and future concepts in stroke prevention.Can Med Assoc J2004; 170: 1123–1133.
3.
3 Powers WJ. Oral anticoagulant therapy for the prevention of stroke.N Engl J Med2001; 345: 1493–1495.
4.
4 Burn JDennis MBamford JSandercock PWade DWarlow C. Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project.Stroke1994; 25: 333–337.
5.
5 Algra AVan Gijn J. Cumulative meta-analysis of aspirin efficacy after cerebral ischaemia of arterial origin.J Neurol Neurosurg Psychiatry1999; 66: 255.
6.
6 Diener HCCunha LForbes CSivenious JSmets PLowenthal A. European Stroke Prevention Study 2 (ESPS-2). Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke.J Neurol Sci1996; 143: 1–13.
7.
7 Halkes PHvan Gijn JKappelle LJKoudstaal PJAlgra A(ESPRIT Study Group). Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial.Lancet2006; 367: 1665–1673.
8.
8 Benavente OHart RKoudstaal PLaupacis AMcBride R. Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database Syst Rev 2000; 2: CD001927. Update in: Cochrane Database Syst Rev2005; 3: CD001927.
9.
9 Saxena RKoudstaal PJ. Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischaemic attack.Cochrane Database Syst Rev2004; 2: CD000185.
10.
10 Connolly SJPogue JHart R. for the ACTIVE Investigators.Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomized controlled trial.Lancet2006; 367: 1903–1912.
11.
11 Hirsh JDalen JEAnderson DR. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range.Chest2001; 119: 8S–21S.
12.
12 Anand SYusuf S. Oral anticoagulant therapy in patients with coronary artery disease: a meta-analysis.JAMA1999; 282: 2058–2067.
13.
13 The Stroke Prevention in Reversible Ischemia Trial (SPIRIT) Study Group. A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin.Ann Neurol1997; 42: 857–865.
14.
14 Hirsh JDalen JEDeykin DPoller LBussey H. Mechanism of action, clinical effectiveness, and optimal therapeutic range.Chest1995; 108: 230S–248S.
15.
15 Baker RNBroward JAFang HC. Anticoagulant therapy in cerebral infarction. Report on cooperative study.Neurology1962; 12: 823–829.
16.
16 Buren AYgge J. Treatment program and comparison between anticoagulants and platelet aggregation inhibitors after transient ischemic attack.Stroke1981; 12: 578–580.
17.
17 Enger EBoyesen S. Long-term anticoagulant therapy in patients with cerebral infarction: a controlled clinical study.Acta Med Scand1965; 178 (suppl 438): 7–61.
18.
18 Garde ASamuelsson KFahlgren HHedberg EHjerne L-GOstman J. Treatment after transient ischemic attacks: a comparison between anticoagulant drug and inhibition of platelet aggregation.Stroke1983; 14: 677–681.
19.
19 Olsson JEBrechter CBacklund H. Anticoagulant vs antiplatelet therapy as prophylactic against cerebral infarction in transient ischemic attacks.Stroke1980; 11: 4–9.
20.
20 Thygesen PChristensen EDyrbye M. Cerebral apoplexy: a clinical, radiological, electroencephalographic and pathological study with special reference to the prognosis of cerebral infarction and the result of long-term anticoagulation therapy.Dan Med Bull1964; 11: 233–257.
21.
21 Wallace DC. Cerebral vascular disease in relation to long-term anticoagulant therapy.J Chron Dis1964; 17: 527–537.
22.
22 Jadad ARMoore ARCarroll D. Assessing the quality of reports of randomized clinical trials: is blinding necessary?Control Clin Trials1996; 17: 1–12.
23.
23 Khan KSDaya SJadad A. The importance of quality of primary studies in producing unbiased systematic reviews.Arch Intern Med1996; 156: 661–666.
24.
24 Mohr JPThompson JLPLazar RM. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke (WARSS).N Engl J Med2001; 345: 1444–1451.
25.
25 Stewart BShuaib AVeloso F. for the SWAT Investigators.Stroke prevention with warfarin or aspirin trial (SWAT).Stroke1998; 29: 304 [abstract].
26.
26 The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group. Warfarin or aspirin for intracranial arterial stenosis.N Engl J Med2005; 325: 1305–1316.
27.
27 The ESPRIT Study Group. Algra A. Medium intensity oral anticoagulants versus aspirin after cerebral ischaemia of arterial origin (ESPRIT): a randomised controlled trial.Lancet Neurol2007; 6: 115–124.
28.
28 Marshall JShaw DA. Anticoagulant therapy in acute cerebrovascular accidents. A controlled trial.Lancet1960; i: 995–998.
29.
29 Carter AB. Anticoagulant treatment in progressing stroke.Br Med J1961; 2: 70–73.
30.
30 Howard FACohen PHickler RLocke SNewcomb TTyler RH. Survival following stroke.JAMA1963; 183: 921–925.
31.
31 Bradshaw PBrennan S. Trial of long-term anticoagulant therapy in the treatment of small stoke associated with a normal carotid arteriogram.J Neurol Neurosurg Psychiatry1975; 38: 642–647.
32.
32 Eriksson S-ELink H. Evaluation of anticoagulants in patients with cerebral infarction with slight to moderate neurological deficit.Acta Neurol Scand1983; 68: 96–106.
33.
33 Chimowitz MIKokkinos JStrong J. The Warfarin–Aspirin Symptomatic Intracranial Disease Study.Neurology1995; 8: 1488–1493.
34.
34 The Warfarin–Aspirin Symptomatic Intracranial Disease (WASID) Study Group. Prognosis of patients with symptomatic vertebral or basilar artery stenosis.Stroke1998; 29: 1389–1392.
35.
35 Elkind MSV. Anticoagulation for secondary stroke prevention: another nail in the coffin?Lancet Neurol2007; 6: 97–99.
36.
36 Hurlen MAbdelnoor MSmith PErikssen JArnesen H. Warfarin, aspirin, or both after myocardial infarction.N Engl J Med2002; 347: 969–974.
37.
37 Anand SS. WAVE Investigators. The effect of oral anticoagulants and antiplatelet therapy among patients with peripheral arterial disease.N Engl J Med2007; 357: 217–227.
38.
38 Sacco RLDiener HCYusuf S. Prevention Regimen For Effectively avoiding Second Strokes (PRoFESS). International Stroke Conference 2005; New Orleans, Louisianna, USA [abstract].
39.
39 Diener HCBogousslavsky JBrass LM.; MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomized, double-blind, placebo-controlled trial.Lancet2004; 364: 331–337.
40.
40 Tran HAnand SS. Oral antiplatelet therapy in cerebrovascular disease, coronary artery disease, and peripheral arterial disease.JAMA2004; 292: 1867–1874.
41.
41 Sacco RAAdams RAlbers G. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack.Stroke2006; 37: 577–617.
42.
42 Hirsh JGuyatt GAlbers GWSchünemann HJ. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.Chest2004; 126: 172S–173S.
