SUMMARY Treatment with an anticoagulant (AC) or acetylsalicylic acid (ASA), chosen at random, was given to 241 patients with symptoms of carotid transient attacks of ischemia, some of whom recovered completely within 24 hours (TIA) while the others had slight residual symptoms (TIA-IR).Cerebral infarction was recorded in 4 patients in each of these treatment groups during a mean follow-up period of 20 months. The incidences of TIA and TIA-IR were also similar in the two groups. Severe hemorrhage occurred more often in the AC group, whereas other side reactions, including gastrointestinal disorders, were more common in the ASA group. Recurrent cerebral ischemic events were significantly more common among the patients that had had 2= 2 TIAs in the 14 days immediately preceding randomiza tion, and in those with a history of CVS symptoms more than 14 days before randomization, or those with a carotid bruits. In the group experiencing 5= 2 TIAs in the 14 days prior to randomization the incidence of recurrent cerebral ischemic events was the same for the two types of treatment.
Stroke, Vol 14, No 5, 1983TRANSIENT ISCHEMIC ATTACKS (TIA) are re garded as a warning sign of impending stroke -a 7% annual incidence of stroke is an often cited figure. was initially re ceived with enthusiasm, but is now used less frequent ly owing to the high risk of complications.3 In the early fifties anticoagulation (AC) therapy, given for varying periods after TIA, was adopted almost as a standard form of treatment, but from a critical review of 27 papers Brust 4 concluded that its effectiveness had not been convincingly proved, either because none of the studies had included randomized control groups or else because the patient series were too small for a mean ingful statistical analysis. Nonetheless, at many cen ters, the administration of anticoagulant is considered to be the treatment of choice for the TIA patient.
5Subsequently, at the time that the role of platelet ag gregation in the development of arterial thromboembo lism was beginning to be understood trials with agents that inhibit this process was undertaken. In an Ameri can study 6 on patients with carotid TIAs it was found that over an initial 6-month period the incidence of the end points mortality, stroke, recurrent TIAs and retinal infarction, taken together, was significantly lower for patients given acetylsalicylic (ASA), than for those receiving placebo. In a Canadian investigation 7 ASA, either alone or in combination with sulfinpyrazone, was found to lower the mortality and the incidence of stroke for men but not for women ./Two Swedish clini cal trials performed on 125 8 and 156 patients 9 the effi cacies of treatment with anticoagulants and agents to inhibit platelet aggregation (acetylsalicylic acid and dipyridamol) were compared. In the former study no significant difference was observed. In the latter study all the patients received AC treatment initial 2 months after TIAs, before randomization was performed. Dur ing a 2-year follow-up the incidence of cerebral ...
