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Evidence summaries

Vitamin K Antagonists Versus Antiplatelet Therapy after TIA or Minor Ischaemic Stroke of Presumed Arterial Origin

For the secondary prevention after TIA or minor stroke of presumed arterial origin, vitamin K antagonists in any dose are not more efficacious than antiplatelet therapy and medium and high intensity anticoagulation leads to a significant increase in major bleeding complications. Level of evidence: "A"

Summary

A Cochrane review [Abstract] 1 included 8 RCTs with a total of 5762 subjects. Oral anticoagulant therapy with vitamin K antagonists (warfarin, phenprocoumon or acenocoumarol) was compared with antiplatelet therapy for long-term secondary prevention after recent transient ischaemic attack (TIA) or minor ischaemic stroke of presumed arterial origin. Anticoagulants in any intensity are not more efficacious in the prevention of vascular events than antiplatelet therapy (medium intensity anticoagulation: RR 0.80, 95% CI 0.56 to 1.14; high intensity anticoagulation: RR 1.02, 95% CI 0.49 to 2.13). There is no evidence that treatment with low intensity anticoagulation (INR 1.4 to 2.8) gives a higher bleeding risk than treatment with antiplatelet agents: RR 1.27 (95% CI 0.79 to 2.03). However, medium and high intensity anticoagulation with vitamin K antagonists (INR of 2.0 to 4.5) were not safe because they yielded a higher risk of major bleeding complications (medium intensity anticoagulation: RR 1.93, 95% CI 1.27 to 2.94; high intensity anticoagulation: RR 9.0, 95% CI 3.9 to 21).

Clinical comments

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References

  • De Schryver EL, Algra A, Kappelle LJ et al. Vitamin K antagonists versus antiplatelet therapy after transient ischaemic attack or minor ischaemic stroke of presumed arterial origin. Cochrane Database Syst Rev 2012;9:CD001342. [PubMed]

Primary/Secondary Keywords