Vitamin K antagonists versus antiplatelet therapy after transient ischaemic attack or minor ischaemic stroke of presumed arterial origin
Key result
Vitamin K antagonists are not more efficacious than antiplatelet therapy for preventing recurrent ischemic stroke after TIA or minor stroke, and medium to high intensity anticoagulation significantly increases major bleeding complications.
Why the study?
Does oral anticoagulant therapy with vitamin K antagonists reduce vascular events compared to antiplatelet therapy in patients with recent transient ischaemic attack or minor ischaemic stroke of presumed arterial origin?
Population
5,762 participants from 8 randomised trials with recent transient ischaemic attack or minor ischaemic stroke…
Comparison
Oral anticoagulant therapy with vitamin K… vs Antiplatelet therapy
Design
Meta-analysis, Randomised trials
Authors
Discussion
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Member takes
Implication
Supports antiplatelet over vitamin K antagonists after TIA or minor stroke; reinforces consensus against routine anticoagulation.
Study Design
Type
Systematic Review (n=5,762)
Structured PICO
Does oral anticoagulant therapy with vitamin K antagonists reduce vascular events compared to antiplatelet therapy in patients with recent transient ischaemic attack or minor ischaemic stroke of presumed arterial origin?
P
Population
5,762 participants from 8 randomised trials with recent transient ischaemic attack or minor ischaemic stroke of presumed arterial origin
I
Intervention
Oral anticoagulant therapy with vitamin K antagonists (warfarin, phenprocoumon or acenocoumarol) in any intensity for long-term secondary prevention
C
Comparator
Antiplatelet therapy
O
Outcome
Prevention of vascular eventscomposite
Main Result
Effect estimate: RR 0.80 (95% CI 0.56-1.14)
Vitamin K antagonists are not more efficacious than antiplatelet therapy for secondary prevention after TIA or minor stroke of arterial origin, but significantly increase the risk of major bleeding.
Limitations
- Varying levels of anticoagulation intensity across included trials
- Method of randomisation concealment was not defined in two trials
- Most included trials were open-label and not blinded for treatment
- Estimation of INR levels was required for older studies that did not specify intensity by INR
Cite This Study
Schryver et al. (2012) conducted a systematic review in Transient ischaemic attack or minor ischaemic stroke of presumed arterial origin (n=5,762). Vitamin K antagonists vs. Antiplatelet therapy was evaluated on Recurrent ischaemic stroke (medium intensity anticoagulation) (RR 0.80, 95% CI 0.56-1.14). Vitamin K antagonists are not more efficacious than antiplatelet therapy for preventing recurrent ischemic stroke after TIA or minor stroke, and medium to high intensity anticoagulation significantly increases major bleeding complications.