Published Online
on May 1, 2003

A more recent version of this article appeared on June 1, 2003

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Submitted on December 13, 2002
Accepted on December 18, 2002

Oral Anticoagulation in Patients After Cerebral Ischemia of Arterial Origin and Risk of Intracranial Hemorrhage

The European/Australasian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT) Study Group^*

From the European/Australasian Stroke Prevention in Reversible Ischemia Trial (ESPRIT) Study Group.

^* To whom correspondence should be addressed. E-mail: a.algra{at}neuro.azu.nl.

Background and Purpose--In the recently published Warfarin Aspirin Recurrent Stroke Study (WARSS), a low-intensity anticoagulation regimen was used because of safety concerns. Such concerns are corroborated by the results of the Stroke Prevention in Reversible Ischemia Trial (SPIRIT), which was stopped early because of a high incidence of intracranial hemorrhage with a target international normalized ratio (INR) of 3.0 to 4.5. In the ongoing European/Australasian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT), an intermediate anticoagulation regimen (INR 2.0 to 3.0) is used.

Methods--We performed an interim analysis of the incidence of intracranial hemorrhage in ESPRIT.

Results--Thus far the overall rate of intracranial hemorrhage is 0.31% (95% CI, 0.18% to 0.52%) per year and 1.21% if all of these were in the anticoagulation group.

Conclusions--We conclude that anticoagulation with achieved INR of 2.0 to 3.0 is reasonably safe in patients with cerebral ischemia of arterial origin.

Key words: anticoagulants • aspirin • cerebral ischemia • intracerebral hemorrhage

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