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document
Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis . BACKGROUND Atherosclerotic intracranial arterial stenosis is an important cause of stroke . Warfarin is commonly used in preference to aspirin for this disorder , but these therapies have not been compared in a randomized trial . METHODS We randomly assigned patients with transient ischemic attack or stroke caused by angiographically verified 50 to 99 percent stenosis of a major intracranial artery to receive warfarin ( target international normalized ratio , 2.0 to 3.0 ) or aspirin ( 1300 mg per day ) in a double-blind , multicenter clinical trial . The primary end point was ischemic stroke , brain hemorrhage , or death from vascular causes other than stroke . RESULTS After 569 patients had undergone randomization , enrollment was stopped because of concerns about the safety of the patients who had been assigned to receive warfarin . During a mean follow-up period of 1.8 years , adverse events in the two groups included death ( 4.3 percent in the aspirin group vs. 9.7 percent in the warfarin group ; hazard ratio for aspirin relative to warfarin , 0.46 ; 95 percent confidence interval , 0.23 to 0.90 ; P=0.02 ) , major hemorrhage ( 3.2 percent vs. 8.3 percent , respectively ; hazard ratio , 0.39 ; 95 percent confidence interval , 0.18 to 0.84 ; P=0.01 ) , and myocardial infarction or sudden death ( 2.9 percent vs. 7.3 percent , respectively ; hazard ratio , 0.40 ; 95 percent confidence interval , 0.18 to 0.91 ; P=0.02 ) . The rate of death from vascular causes was 3.2 percent in the aspirin group and 5.9 percent in the warfarin group ( P=0.16 ) ; the rate of death from nonvascular causes was 1.1 percent and 3.8 percent , respectively ( P=0.05 ) . The primary end point occurred in 22.1 percent of the patients in the aspirin group and 21.8 percent of those in the warfarin group ( hazard ratio , 1.04 ; 95 percent confidence interval , 0.73 to 1.48 ; P=0.83 ) . CONCLUSIONS Warfarin was associated with significantly higher rates of adverse events and provided no benefit over aspirin in this trial . Aspirin should be used in preference to warfarin for patients with intracranial arterial stenosis .
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Intervention_Pharmacological
warfarin
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Intervention_Pharmacological
aspirin
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Intervention_Pharmacological
warfarin
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Intervention_Pharmacological
aspirin
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Intervention_Pharmacological
warfarin .
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Intervention_Pharmacological
aspirin
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Intervention_Pharmacological
aspirin
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Intervention_Pharmacological
warfarin
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Intervention_Pharmacological
Warfarin
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Intervention_Pharmacological
Aspirin
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Outcome_Physical
ischemic stroke
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Outcome_Physical
brain hemorrhage
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Outcome_Mortality
death
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Outcome_Physical
stroke
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Outcome_Adverse-effects
adverse events
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Outcome_Mortality
death
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Outcome_Physical
major hemorrhage
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Outcome_Physical
myocardial infarction
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Outcome_Mortality
sudden death
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Outcome_Mortality
rate of death
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Outcome_Mortality
rate of death
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Participant_Condition
patients with intracranial arterial stenosis .