 |
 |
|
|
|  PubMed
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
5 January 1999 | Volume 130 Issue 1 | Pages 14-22
Background: Complication rates of medical therapy for secondary stroke prevention derived from clinical trials may or may not be applicable to patients with cerebrovascular disease in the general population.
Objective: To determine complication rates for aspirin, warfarin, and intravenous heparin administered for secondary stroke prevention after first episodes of ischemic stroke, transient ischemic attack, or amaurosis fugax in a community.
Design: Population-based historical cohort study.
Setting: Rochester, Minnesota.
Patients: All residents of Rochester who, between 1985 and 1989, received aspirin (n = 339) or warfarin (n = 145) within 2 years after first ischemic stroke, transient ischemic attack, or amaurosis fugax or received intravenous heparin (n = 201) within 2 weeks after first ischemic stroke, transient ischemic attack, or amaurosis fugax.
Measurements: Occurrence of major complications caused by therapy.
Results: Twenty aspirin-associated complications (1 fatal) occurred during an average 1.7 years of treatment, 8 warfarin-associated complications occurred during an average 0.7 years of treatment, and 3 heparin-associated complications (1 fatal) occurred during an average 5.1 days of treatment. Complication rates were 3.5 per 100 person-years (95% CI, 2.1 to 5.4) for aspirin, 7.9 per 100 person-years (CI, 3.4 to 15.6) for warfarin, and 0.30 (CI, 0.06 to 0.86) per 100 person-days for heparin. Rates of fatal complications were 0.2 per 100 person-years (CI, 0 to 1.0) for aspirin, 0 per 100 person-years (CI, 0 to 3.6) for warfarin, and 0.10 per 100 person-days (0 to 0.55) for heparin.
Conclusions: Complication rates for warfarin and intravenous heparin given as therapy for secondary stroke prevention in Rochester, Minnesota, were lower than rates reported from earlier trials and observational studies. However, complication rates for warfarin were higher than in more recent referral-based studies and multicenter randomized trials. After adjustment for duration of therapy, complication rates for heparin were higher than those for aspirin or warfarin. These rates can be used to judge the applicability of complication rates derived from ongoing clinical trials.
Author and Article Information
From the Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Requests for Reprints: George W. Petty, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Current Author Addresses: Drs. Petty, Brown, Whisnant, O'Fallon, and Wiebers and Ms. Sicks: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Grant Support: In part by grants from the Agency for Health Care Policy and Research (282910028) and from the National Institute of Neurological Disorders and Stroke (NS06663). ARTICLE
Frequency of Major Complications of Aspirin, Warfarin, and Intravenous Heparin for Secondary Stroke Prevention: A Population-Based Study
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  M. D. Caldwell, T. Awad, J. A. Johnson, B. F. Gage, M. Falkowski, P. Gardina, J. Hubbard, Y. Turpaz, T. Y. Langaee, C. Eby, et al. CYP4F2 genetic variant alters required warfarin dose Blood, April 15, 2008; 111(8): 4106 - 4112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Holbrook, R. Labiris, C. H. Goldsmith, K. Ota, S. Harb, and R. J. Sebaldt Influence of decision aids on patient preferences for anticoagulant therapy: a randomized trial Can. Med. Assoc. J., May 22, 2007; 176(11): 1583 - 1587. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Glueck, K. Golnik, and Ping Wang Amaurosis Fugax Caused by Heritable Thrombophilia-Hypofibrinolysis in Cases Without Carotid Atherosclerosis: Thromboprophylaxis Prevents Subsequent Transient Monocular Partial Blindness Clinical and Applied Thrombosis/Hemostasis, April 1, 2007; 13(2): 124 - 129. [Abstract] [PDF]
|
|
|
|
 |
|
 R. T. Meenan, S. Saha, R. Chou, K. Swarztrauber, K. Pyle Krages, M. C. O'Keeffe-Rosetti, M. McDonagh, B. K. S. Chan, M. C. Hornbrook, and M. Helfand Cost-Effectiveness of Echocardiography to Identify Intracardiac Thrombus among Patients with First Stroke or Transient Ischemic Attack Med Decis Making, March 1, 2007; 27(2): 161 - 177. [Abstract] [PDF]
|
|
|
|
 |
|
 K. I. Paraskevas, S. S. Daskalopoulou, M. E. Daskalopoulos, and C. D. Liapis Secondary Prevention of Ischemic Cerebrovascular Disease. What Is the Evidence? Angiology, September 1, 2005; 56(5): 539 - 552. [Abstract] [PDF]
|
|
|
|
 |
|
 A. E. Epstein, J. C. Alexander, D. D. Gutterman, W. Maisel, and J. M. Wharton Anticoagulation: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 24S - 27S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Glueck, N. Goldenberg, H. Bell, K. Golnik, and P. Wang Amaurosis Fugax: Associations with Heritable Thrombophilia Clinical and Applied Thrombosis/Hemostasis, July 1, 2005; 11(3): 235 - 241. [Abstract] [PDF]
|
|
|
|
 |
|
 F Landi, M Cesari, G Onder, V Zamboni, F Lattanzio, A Russo, C Barillaro, and R Bernabei Antithrombotic drugs in secondary stroke prevention among a community dwelling older population J. Neurol. Neurosurg. Psychiatry, August 1, 2003; 74(8): 1100 - 1104. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. van Walraven, R. G. Hart, G. A. Wells, P. Petersen, P. J. Koudstaal, A. L. Gullov, B. S. P. Hellemons, B. G. Koefed, and A. Laupacis A Clinical Prediction Rule to Identify Patients With Atrial Fibrillation and a Low Risk for Stroke While Taking Aspirin Arch Intern Med, April 28, 2003; 163(8): 936 - 943. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Quilliam, K. L. Lapane, C. B. Eaton, and V. Mor Effect of Antiplatelet and Anticoagulant Agents on Risk of Hospitalization for Bleeding Among a Population of Elderly Nursing Home Stroke Survivors Stroke, October 1, 2001; 32(10): 2299 - 2304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B.-Q. Zhao, Y. Suzuki, K. Kondo, Y. Ikeda, and K. Umemura Combination of a Free Radical Scavenger and Heparin Reduces Cerebral Hemorrhage After Heparin Treatment in a Rabbit Middle Cerebral Artery Occlusion Model Stroke, September 1, 2001; 32(9): 2157 - 2163. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. T. Neilipovitz, G. L. Bryson, and G. Nichol The Effect of Perioperative Aspirin Therapy in Peripheral Vascular Surgery: A Decision Analysis Anesth. Analg., September 1, 2001; 93(3): 573 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Quilliam, K. L. Lapane, and C. Leibson Clinical Correlates and Drug Treatment of Residents With Stroke in Long-Term Care Editorial Comment Stroke, June 1, 2001; 32(6): 1385 - 1393. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S J McNulty, D Hutchinson, and K J Hardy Implementation of antithrombotic management in atrial fibrillation Postgrad. Med. J., December 1, 2000; 76(902): 783 - 786. [Abstract] [Full Text]
|
|
|
|
|
|
G. W. Petty, B. K. Khandheria, J. P. Whisnant, J. D. Sicks, W. M. O'Fallon, and D. O. Wiebers Predictors of Cerebrovascular Events and Death Among Patients With Valvular Heart Disease : A Population-Based Study Stroke, November 1, 2000; 31(11): 2628 - 2635. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. S. Wong, V. Mok, W. W. M. Lam, R. Kay, A. Tang, Y. L. Chan, and J. Woo Aspirin-associated intracerebral hemorrhage: Clinical and radiologic features Neurology, June 27, 2000; 54(12): 2298 - 2301. [Abstract] [Full Text] [PDF]
|
|
