Key result
Long-term anticoagulant treatment normalized the risk of subsequent stroke in TIA and stroke patients, but did not reduce mortality and was associated with serious bleeding complications.
Why the study?
Does long-term anticoagulant treatment reduce mortality and subsequent stroke in patients with TIA and stroke?
Cohort (n=90)
Does long-term anticoagulant treatment reduce mortality and subsequent stroke in patients with TIA and stroke?
Long-term anticoagulation in TIA and stroke patients reduces the risk of subsequent stroke but does not improve mortality and carries a high risk of serious bleeding complications.
Answers are grounded in this paper and cite their sources.
Long-term anticoagulation warrants caution in TIA/stroke due to bleeding without survival gain; leaves open randomized confirmation in modern cohorts.
Long-term anticoagulant treatment was given to 25 patients with transient ischemic attacks (TIA) and 49 stroke patients with reversible ischemic neurological deficit or cerebral embolism. Another 16 TIA patients were observed without anticoagulant treatment. Life table analyses, comparing the observed with the expected frequency, revealed increased mortality in the TIA patients irrespective of whether or not they had received anticoagulants. The stroke patients treated with anticoagulants also had a higher mortality than expected. On the other hand, the incidence of subsequent stroke was not higher than expected in the TIA and stroke patients treated with anticoagulants, while it was significantly increased in the TIA patients not treated with anticoagulants. Thus, the risk of stroke, but not the risk of death, was normalized by the anticoagulant treatment. Unacceptably serious bleeding complications were seen in the group of stroke patients with anticoagulant treatment. Bleeding complications, in both TIA and stroke patients, seemed to be related to lengthy treatment, high blood pressure on admission or insufficient patient compliance.
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Terént et al. (1980) conducted a cohort in Transient ischemic attacks and stroke (n=90). Long-term anticoagulant treatment vs. No anticoagulant treatment / expected frequency was evaluated on Mortality and subsequent stroke. Long-term anticoagulant treatment normalized the risk of subsequent stroke in TIA and stroke patients, but did not reduce mortality and was associated with serious bleeding complications.
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