[Prevention of recurrent ischemic stroke: recent clinical trial results]

Clinical trials are providing new insights into long-existing clinical biases for the treatment of acute ischemic stroke and prevention of recurrence. The structure and completeness of the data sets available for some of the published studies have raised controversies about the generality of some of the findings. Among these controversies for acute ischemic stroke are whether the benefits of so-called low-dose unfractionated heparin exceed or are negated by hemorrhagic complications and whether results with heparinoids can be considered a surrogate for unfractionated heparin. For prevention of recurrent ischemic stroke, a double-blind study showed no statically-significant differences for serious hemorrhagic complications nor for prevention of recurrence in non-cardioembolic stroke for aspirin 325 mg daily against adjusted-dose warfarin with an INR 1.4-2.8, the INR value which showed clinical benefit in prevention of first stroke with atrial fibrillation. In this study, patent cardiac foramen ovale and antiphospholipid antibody status did not predict stroke recurrence. Other platelet antiaggregants show varying degrees of reduction in recurrent ischemic stroke compared with placebo or aspirin but the recurrent events rates make it difficult to compare directly through meta-analysis the results against warfarin. More work on these important management issues is justifiable.