Key result
Secondary prophylactic treatment with anticoagulants (OR 0.67) or antiplatelet therapy (OR 0.67) improved survival compared to no treatment in patients with a history of TIA or ischemic stroke.
Why the study?
Does secondary prophylactic treatment with anticoagulants or antiplatelets improve survival in patients with a history of TIA or stroke compared to no treatment?
Observational (n=549)
No
Does secondary prophylactic treatment with anticoagulants or antiplatelets improve survival in patients with a history of TIA or stroke compared to no treatment?
Secondary prophylaxis with anticoagulants or aspirin significantly improves long-term survival in patients following TIA or stroke compared to no treatment.
Answers are grounded in this paper and cite their sources.
May support secondary prophylaxis post-TIA/stroke; leaves open confirmation by randomized trials.
OBJECTIVES: To assess long-term prognosis after transient ischemic attack (TIA)/subtypes of stroke relative to secondary prophylactic treatment(s) given. MATERIALS AND METHODS: Retro/prospective follow-up of patients hospitalized in the Stroke Unit or in the Department of Neurology, Linköping, in 1986 and followed up to Feb. 2011. RESULTS: A total of 288 men were followed up for 2254 years (mean 7.8 years) and 261 women for 1984 years (mean 7.6 years). In men, the distribution to anticoagulants (AC) (warfarin treatment) was 18%, antiplatelet therapy (APT) usually ASA 75 mg/day 54%, untreated 27%, unknown 2%. In women, the distribution to AC was 15%, APT 60%, untreated 23%, unknown 2%, respectively. Mortality rates at 1 year, 10 years, and 25 years for men were 21%, 67%, and 93%, respectively, versus the rates in women of 24%, 71%, and 90%, respectively. Survival curves showed markedly increased risk of death compared to the normal population. AC treatment was more favorable for men regarding the annual risk of stroke, compared with APT (9.4% vs. 9.8%), as well as the risks of MI, (5.6% vs. 6.7%), and death (8.1% vs. 10.3%), compared to women for stroke (11.6% vs. 8.8%) and MI (5.3% vs. 3.7%) but not for death (8.3% vs. 8.4%). The risk of fatal bleeding was 0.86% annually on AC compared to 0.17% on APT. According to Cox regression analysis included patients with TIA/ischemic stroke, first-line treatment had beneficial effects on survival: AC OR 0.67 (0.5-0.9), APT 0.67 (0.52-0.88) versus untreated. CONCLUSIONS: Patients with a history of TIA/stroke had a higher mortality rate versus controls, providing support for both primary and secondary prophylaxis regarding vascular risk factors for death. This study also provided support for secondary prophylactic treatment with either AC or ASA (75 mg once daily) to reduce the vascular risk of death unless there are contraindications.
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Sven‐Erik Eriksson (2016) conducted an observational in TIA and subtypes of stroke (n=549). Anticoagulants (AC) or Antiplatelet therapy (APT) vs. Untreated was evaluated on Survival (OR 0.67 for AC, OR 0.67 for APT, 95% CI 0.5-0.9 for AC, 0.52-0.88 for APT). Secondary prophylactic treatment with anticoagulants (OR 0.67) or antiplatelet therapy (OR 0.67) improved survival compared to no treatment in patients with a history of TIA or ischemic stroke.
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