Oral anticoagulants versus antiplatelet therapy for preventing further vascular events after transient ischemic attack or minor stroke of presumed arterial origin.

Abstract

Patients who are entered in clinical trials after a transient ischemic attack or nondisabling ischemic stroke have an annual risk of important vascular events (death from all vascular causes, nonfatal stroke, or nonfatal myocardial infarction) of between 4% and 11%.1,2 Aspirin, in a daily dose of 30 mg or more, offers only modest protection after cerebral ischemia: it reduces the incidence of major vascular events by 20% at most.1–3 Secondary prevention trials after myocardial infarction indicate that treatment with oral anticoagulants is associated with a risk reduction approximately twice that of treatment with antiplatelet therapy.1,4–7 This review aimed to (1) compare the efficacy of oral anticoagulants and antiplatelet therapy in the secondary prevention of vascular events after cerebral ischemia of presumed arterial origin and (2) compare the safety of oral anticoagulants and antiplatelet therapy in the secondary prevention of vascular events after cerebral ischemia of presumed arterial origin. This review draws on the search strategy developed for the Cochrane Stroke Review Group as a whole. Relevant trials …