@entity117 is only modestly effective in the secondary prevention after @entity2806 . Studies in other @entity455 suggest that anticoagulant drugs in @entity1 with @entity2806 of presumed arterial (noncardiac) origin might be more effective. The aim of the @entity64 Prevention in Reversible @entity63 Trial (SPIRIT) therefore was to compare the efficacy and safety of 30 mg @entity117 daily and oral anticoagulation (international normalized ratio [INR] 3.0-4.5). @entity1 referred to a neurologist in one of 58 collaborating centers because of a transient @entity63 attack or minor @entity385 (Rankin grade < or =3) were eligible. Randomization was concealed, treatment assignment was open, and assessment of outcome events was masked. The primary measure of outcome was the composite event "death from all vascular causes, nonfatal @entity64 , nonfatal @entity583 , or nonfatal major @entity548 complication." The trial was stopped at the first interim analysis. A total of 1,316 @entity1 participated; their mean follow-up was 14 months. There was an excess of the primary outcome event in the anticoagulated group (81 of 651) versus 36 of 665 in the @entity117 group (hazard ratio, 2.3; 95% confidence interval [CI], 1.6-3.5). This excess could be attributed to 53 major @entity548 complications (27 intracranial; 17 fatal) during anticoagulant therapy versus 6 on @entity117 (3 intracranial; 1 fatal). The @entity548 incidence increased by a factor of 1.43 (95% CI, 0.96-2.13) for each 0.5 unit increase of the achieved INR. Anticoagulant therapy with an INR range of 3.0 to 4.5 in @entity1 after @entity2806 of presumed arterial origin is not safe. The efficacy of a lower intensity anticoagulation regimen remains to be determined.

A randomized trial of anticoagulants versus @entity117 after XXXX of presumed arterial origin. The @entity64 Prevention in Reversible @entity63 Trial (SPIRIT) Study Group.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke', 'Stroke'] @entity455 :: ('MESH:D014652', 'Disease') :: ['vascular disorders'] @entity2806 :: ('MESH:D002545', 'Disease') :: ['cerebral ischemia'] @entity63 :: ('MESH:D007511', 'Disease') :: ['Ischemia', 'ischemic'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding'] @entity117 :: ('MESH:D001241', 'Chemical') :: ['Aspirin', 'aspirin'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity385 :: ('MESH:D002544', 'Disease') :: ['ischemic stroke']
@entity2806 :: (MESH:D002545,Disease) :: ['cerebral ischemia']
