Comparison of Warfarin and Aspirin for Symptomatic Intracranial Arterial Stenosis

Stroke or transient ischemic attack due to intracranial arterial stenosis is usually treated with warfarin. The results of the current trial refute this practice and suggest that warfarin results in an increased mortality rate. Aspirin (1300 mg per day) is the recommended therapy. The results of this trial suggest that warfarin for intracranial arterial stenosis results in an increased mortality rate. Aspirin is the recommended therapy. Atherosclerotic stenosis of the major intracranial arteries is an important cause of stroke, especially in blacks, Asians, and Hispanics. 1 – 3 Of the 900,000 strokes or transient ischemic attacks that occur each year in the United States, 4 , 5 approximately 70,000 to 90,000 are caused by intracranial arterial stenosis. 3 The risk of recurrent stroke in these patients may be as high as 15 percent per year. 6 , 7 Despite their high risk of stroke, there are no prospective studies comparing antithrombotic therapies in these patients. Anticoagulation was first used to treat intracranial arterial stenosis in 1955, 8 and subsequent, retrospective studies suggested that warfarin . . .