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(Stroke. 2005;36:933.)
© 2005 American Heart Association, Inc.

Letters to the Editor

Oral Anticoagulation in Secondary Prevention After Cerebral Ischemia of Arterial Origin

P.H.A. Halkes, MD for the ESPRIT Study Group

Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands

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

Letter to the Editor:

We react to the article by Amarenco and Donnan¹ in which they discuss stroke prevention strategies after publication of the MATCH trial. In our opinion, they rush to conclusions about the value of oral anticoagulants in the secondary prevention after noncardioembolic stroke.

SPIRIT² did not show that oral anticoagulants were inferior to aspirin in terms of efficacy and net benefit to prevent stroke and death in patients with a noncardioembolic stroke, as stated by the authors. SPIRIT was designed to compare the efficacy and benefit of oral anticoagulants with those of aspirin, but the trial was stopped early because of an excessively high incidence of major bleeding complications in the anticoagulation group. The only conclusion that can be drawn from this trial is that oral anticoagulants with an aimed INR of 3.0 to 4.5 are not as safe as aspirin in patients with a noncardioembolic stroke. The limited number of patients in the trial and the short follow-up do not allow conclusions on the efficacy in preventing stroke; the 95% confidence interval for ischemic events ranged from a 40% benefit for anticoagulants to a 43% benefit for aspirin. From SPIRIT and WARSS,³ together it may be inferred that anticoagulation is not the therapy of choice if its target INR is either high (SPIRIT: 3.0 to 4.5, average 3.3) or low (WARSS: 1.4 to 2.8, average 2.0). However, this leaves an intermediate target (2.0 to 3.0) for which no efficacy data in the prevention of stroke are . . . [Full Text of this Article]