This Article Full Text Full Text (PDF) All Versions of this Article: 34/6/e46    most recent 01.STR.0000072821.77040.FDv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hennerici, M.G. Search for Related Content PubMed PubMed Citation Articles by Hennerici, M.G. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID WARFARIN Medline Plus Health Information Blood Thinners Stroke

(Stroke. 2003;34:e46.)
© 2003 American Heart Association, Inc.

Research Reports

Editorial Comment: Low-Dose or Moderate-Dose Anticoagulation: Dream or Hope for Stroke Prevention?

Department of Neurology, University of Heidelberg, Mannheim, Germany

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The preliminary contribution by the European/Australian Stroke Prevention in Reversible Ischemia Trial (ESPRIT) Study Group¹ supports the idea that ESPRIT might settle the issue after Stroke Prevention in Reversible Ischemia Trial (SPIRIT)² and Warfarin Aspirin Recurrent Stroke Study (WARSS)³ as to whether or not patients with noncardioembolic ischemic stroke benefit from oral anticoagulation versus platelet inhibition in secondary prevention of stroke. Ale Algra, on behalf of the ESPRIT Study Group, argues in favor of this hypothesis and claims that their study continues after WARSS so as not to miss the likelihood that moderate anticoagulation (international normalized ratio [INR] values, 2.0 to 3.0) is more effective than lower values (INR, 1.5 to 2.8 as reported in WARSS) but less dangerous than higher ones (INR, 3.0 to 4.5 as reported in SPIRIT). The data presented in this article suggest that the latter is true, ie, that major hemorrhages such as observed in SPIRIT in excess—which caused premature discontinuation of this study—are unlikely to occur in ESPRIT. Even if this observation is finally confirmed once ESPRIT is finished, however, the chances are small that oral anticoagulation will turn out to be more effective if achieved with slightly higher values than those gained in WARSS. However, limitations of the data available from the ESPRIT study at this stage prevent any scientifically reasonable prediction because ESPRIT is an open-labeled rather than a double-blind, randomized trial (like WARSS), yet it has unknown variability of target INR ranges in individual subjects. WARSS was very effective in this . . . [Full Text of this Article]

This article has been cited by other articles:

				ESPRIT ESPRIT: Safety and Efficacy of Oral Anticoagulation--a Rebuttal Stroke, October 1, 2003; 34 (10): e184 - e184. [Full Text] [PDF]