Posted on 03/30/2005 9:42:17 PM PST by neverdem
Doctors should consider treating people at risk of developing strokes caused by narrowed arteries in the brain with aspirin instead of warfarin, a common anti-clotting drug, new research suggests.
The study, conducted at more than 50 sites across North America, was done on 569 patients who had suffered a stroke or mini-stroke as a result of a condition called symptomatic intracranial arterial stenosis. It is caused by the buildup of fatty deposits in the arteries' inner walls, restricting blood flow.
Those patients on warfarin, which is marketed as Coumadin, suffered a higher death rate and more major bleeding compared with those who took aspirin.
It's not known how many people have stenosis, but it causes about 10 percent of the 900,000 strokes and mini-strokes that occur in the United States each year.
People with the condition currently take aspirin or warfarin to reduce stroke risk. Both work by thinning the blood, a defense against clots that can block blood vessels.
Dr. Marc Chimowitz, a neurologist at Emory University and lead author of the study, said people with stenosis should not stop taking warfarin or start an aspirin regimen without consulting their doctors.
He also noted that previous studies have shown that warfarin is useful in preventing strokes in people with other conditions like irregular heartbeat and clots in the legs and lungs.
In the latest study, patients randomly took either warfarin or high-dose aspirin. The aspirin group was given a daily dose of 1,300 milligrams, a higher amount than is recommended for heart disease and general stroke prevention. Researchers used the higher dose based on previous studies on its effectiveness. It was unclear whether another aspirin dose would lead to better results, Chimowitz said.
During follow-up, about one in five patients died from circulatory problems, had a second stroke or...
(Excerpt) Read more at startribune.com ...
A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women
That study was announced a few weeks ago, IIRC, which showed a decrease strokes. It's the whole article, a freebee.
FReepmail me if you want on or off my health and science ping list.
This does explain why there has been a renewed interest in buffered and enteric-coated aspirin used in a regular fashion for people with circulatory problems.
I take an asprin every day.
aspirin - the original wonder drug
My mom had a stroke a couple of months ago (completely occluded left carotid artery), and they have her on enteric coated aspirin 1xday.
My Dad had a major stroke nine years ago. He takes Coridin 325 mg.
Thanks for posting this.
I think it's time for me to start taking an aspirin a day.
Go tell your doc, and get regular check-ups. Aspirin is one of the greatest drugs ever discovered, but it can still cause adverse drug reactions, the most common being bleeding ulcers and decreasing kidney function.
"but it can still cause adverse drug reactions, the most common being bleeding ulcers and decreasing kidney function."
Even coated aspirins?
Even if taken once every two-three days and small dosage (325 mg)?
I get several health newsletters and the docs are fighting over this. Some say it's not worth the risk because of ulsers and others say it's a life saver ?
Yes, check the adverse reactions of Ecotrin. That link doesn't mention all of them.
Even if taken once every two-three days and small dosage (325 mg)?
Yes, see your doc, and tell them what you're doing.
One of the criticisms that could be leveled at the second link in comment# 1 is that it was 100 milligrams of aspirin every other day. What if it was 75 or 81 milligrams of aspirin every day? Would that have shown a significant reduction of myocardial infarction, medical lingo for the death of heart tissue, in females, as well as show a benefit against ischemic stroke?
I just started taking an 81 mg asprin a day. I had a physical in Feb and the Dr told me that , even though I don't have any problems of any type, she recommended I take one a day. Its all I take beside my normal vitamins.
I had a dissected carotid artery a little over a year ago. Luckily, the CT scan didn't show a stroke...they put me on Plavix for six months, then 1 aspirin a day. The trouble is I was found to be severely anemic at the same time due to the NSAIDs I took regularly. Now THOSE drugs are dangerous.
He, also, recommended a glass of red wine with dinner each night. Most of the time I prefer a good micro brew, and now the data shows that for prevention of heart attacks that a beer at night works as well as the red wine.
It is best to know your family history re diseases and longevity and share this with your doctor.
I had a severe heart attack at age 47. I started taking enteric aspirin immediately thereafter, and continued until about five years ago. Frequent atrial fibrillation caused my cardiologist to switch me to warfarin. Afib brings substantial danger of blood clots and strokes.
Had 6-bypass open heart surgery at age 54.
I'm now 78. A recent coronary angiogram showed the bypasses to still be open after 23 years. Haven't had any strokes. Am in good health otherwise.
I'm on Lipitor, and have been for years for choloresterol.
There's a place for both aspirin and warfarin. But not together.
Aspirin and Warfarin together is a killer combo.
We have a friend with a shunt and was on warfarin, which caused all types of problems.
He now has a new shunt with the antibiotics and other stuff embedden. His cardiologist took him off of Warfarin and put him back on Aspirin after he had a stroke last summer. He is doing very well.
I hope you still see your doc regularly.
They may well have collected family history on entry into the study. I would be surprised if they didn't. Often there are so many confounding variables that they can't make sense of them or the specific history is lacking such as was there a clotting disorder, i.e. hypercoaguable, or what type of stroke it was. I doubt if most patients could tell whether their parents had an ischemic stroke, which happens about 80 percent of the time, or a hemorrhagic stroke, which happens about 15 percent of the remainder and has a worse prognosis, IIRC. Check Genetics of cerebrovascular disorders. They didn't even mention moyamoya.
Besides that, the population for this study of 569 patients already had a unique diagnosis. From the abstract linked in comment# 1:
"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."
My Dad had a series of small strokes in his late 60's, and his doctor put him on half an aspirin a day. Eventually the effects of the strokes disappeared, and he was stroke free until he died in his late 70's.
It sounds like your father had some type of what was formerly called a RIND.
His diagnosis in the late 1960's, he had a TIA and maybe a couple more.
It impacted his speech for a few months and his vision. Also, he complained about his right shoulder. That was probably due to going back fly fishing post stroke and trying to cast big bass flies into the wind.
His vision returned to normal for distance. He had to wear reading glasses for about a year during the daytime and forever in the evening. My Father, my Mother and I both developed second vision in our early 60's. We went from near sighted to 20/20. I stopped using reading glasses except in the evening after the sun goes down.
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