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Aspirin or anticoagulants in stenosis of the middle cerebral artery: A randomized trial
J Martí-Fàbregas1, D Cocho, J-L Martí-Vilalta
1Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. jmarti@santpau.es
Insights
Aspirin effectively prevents vascular events in patients with symptomatic middle cerebral artery (MCA) stenosis, showing promise as a preferred treatment over oral anticoagulants (OA). This finding supports aspirin for stroke prevention in MCA stenosis patients.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Symptomatic stenosis of the middle cerebral artery (MCA) poses a significant risk for vascular events.
- Comparing aspirin and oral anticoagulants (OA) is crucial for optimal patient management.
Purpose of the Study:
- To compare the efficacy of aspirin versus oral anticoagulants (OA) in preventing vascular events.
- To evaluate treatment strategies for patients with symptomatic middle cerebral artery (MCA) stenosis.
Main Methods:
- An open, randomized, multicenter trial involving 28 patients with symptomatic MCA stenosis.
- Patients received either 300 mg/day aspirin or OA (target INR 2-3).
- Primary endpoint included nonfatal cerebral infarct (CI), myocardial infarct, vascular death, and major hemorrhage, with follow-up of 1-3 years.
Main Results:
- No recurrent cerebral infarct (CI) was observed in either group after a mean follow-up of 23.1 months.
- The aspirin group had zero vascular events, while the oral anticoagulant (OA) group experienced 2 events (1 acute myocardial infarct, 1 intracerebral hemorrhage).
- The observed difference in vascular events between aspirin and OA was not statistically significant (p = 0.48).
Conclusions:
- Aspirin demonstrates potential as a primary treatment for preventing vascular events in symptomatic MCA stenosis.
- The findings suggest aspirin may be the preferred therapeutic option for this patient population.
- Further research may solidify aspirin's role in managing MCA stenosis to prevent cerebrovascular events.
Background:
We report the results of an open, randomized, multicenter trial that compared the efficacy of aspirin to oral anticoagulants (OA) for the prevention of vascular events in patients with symptomatic stenosis of the middle cerebral artery (MCA).
Methods:
Participants were randomly assigned to receive 300 mg/day of aspirin or a dose of OA (target INR 2-3). The MCA stenosis was demonstrated by conventional angiography or by at least two noninvasive examinations. Patients had either transient ischemic attack or cerebral infarct (CI) attributable to the MCA stenosis within 90 days before inclusion. The primary endpoint was: nonfatal CI, nonfatal acute myocardial infarct, vascular death and major hemorrhage. The patients were followed-up for a minimum of 1 year and a maximum of 3 years.
Results:
The study included 28 patients (14 in each treatment group); the average age was 67 +/- 9.9 years. Men constituted 68% of the patients. After a mean follow-up of 23.1 +/- 10.9 months, there were no recurrences of CI in both groups. No endpoint was reported in the aspirin group, but 2 patients in the OA group (14.3%) exhibited vascular events: 1 acute myocardial infarct and 1 intracerebral hemorrhage). However, this difference was not statistically significant (p = 0.48).
Conclusions:
Our study suggests that aspirin is the treatment of choice for the prevention of vascular events in patients with symptomatic MCA stenosis.
