There is new research out tonight that affects the way thousands of stroke patients, or those at high risk for stroke, are treated. The issue: should these patients take aspirin or a blood thinner called coumadin?
This study looked specifically at blockages of the arteries that are inside the head, above the neck. It’s these patients who are most at risk for another stroke, and dying.
So the question is, how best to treat them long term?

There is new research out that affects the way thousands of stroke patients, or those at high risk for stroke, are treated. The issue: should these patients take aspirin or a blood thinner called coumadin?

This study looked specifically at blockages of the arteries that are inside the head, above the neck. It’s these patients who are most at risk for another stroke, and dying. So the question is, how best to treat them long term?

Doctors are concerned specifically about how to best keep that blood from clotting and totally blocking off the flow of blood to the brain. Should it be coumadin--or warfarin--a drug that blocks the clotting factors; or drugs like aspirin which block the platelet cells.

Dr. Stanley Tuhrum, Director of the Stroke Center at Mt. Sinai Medical Center, New York, says, “They make the platelets less sticky and therefore the blood is less likely to clot or the platelet is less likely to clog and form emboli and block an artery.” Now, new research in the New England Journal of Medicine says that these patients with these high risk blockages should be placed on high dose aspirin, four adult ones a day, rather than coumadin or warfarin.

The reason: while both did the same job at preventing a second stroke, patients on coumadin had a much higher risk of a major bleeding episode, such as needing a transfusion or even surgery. That’s because the levels need to be followed closely, and they are difficult to maintain in the correct therapeutic range.

In fact, the INR--the blood level of coumadin--was only in the correct range 63% of the time, meaning, it’s either too high—a bleeding risk—or too low—a clotting risk. There were also higher rates of heart attack and sudden cardiac death as well…perhaps because aspirin may decrease the inflammation that has now been shown to play a big role in atherosclerotic blockages of blood vessels.

But even though aspirin minimizes the bleeding risk, this treatment is not perfect, as many people with these dangerous blockages often have another cardiovascular event or stroke.

“The recurrence event rate is unacceptably high in these patients. This is not a good disease to have, and we really need to find better treatments,” says Dr. Tuhrim.
The study clearly showed that 22% of patients with artery blockages in the head had some sort of stroke or death from vascular disease in general within two years. That’s why it’s important to find the best way to treat these patients and prevent clotting.

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