NEUROLOGY 1993;43:32
© 1993 American Academy of Neurology
Ischemic stroke in patients with atrial fibrillation
Effect of aspirin according to stroke mechanism
V. T. Miller, MD,
J. F. Rothrock, MD,
L. A. Pearce, MS,
W. M. Feinberg, MD,
R. G. Hart, MD,
D. C. Anderson, MD on behalf of the Stroke Prevention in Atrial Fibrillation investigators
Ischemic strokes occurring in patients with nonrheumatic atrial fibrillation are due to a variety of mechanisms, not exclusively to cardiogenic embolism. Without knowledge of antithrombotic therapy assignment, we categorized strokes in the Stroke Prevention in Atrial Fibrillation Study as presumed cardioembolic or noncardioembolic. We then compared patient clinical and echocardiographic variables, as well as the efficacy of aspirin prophylaxis, for each stroke type. Of 71 ischemic strokes, we categorized 46 (65%) as cardioembolic, 13 (18%) as noncardioembolic, and 12 (17%) as of uncertain cause. Patients developing noncardioembolic strokes, relative to cardioembolic strokes, were more commonly men (p = 0.005) and were more likely to have left ventricular wall motion abnormalities by two-dimensional echocardiography (p = 0.002). Aspirin reduced the occurrence of strokes categorized as noncardioembolic significantly more than it did those categorized as cardioembolic (p = 0.01). These results emphasize the value of considering stroke mechanisms in therapeutic trials of antithrombotic agents and suggest a differential effect of aspirin according to mechanism.
Address correspondence and reprint requests to Lesly A. Pearce, Statistics and Epidemiology Research Corporation, 1107 NE 45th Street, Suite 520, Seattle, WA 98105.
Supported by grant R01-NS-24424 from the Division of Stroke and Trauma, National Institute of Neurological Disorders and Stroke.
Received March 4, 1992. Accepted for publication in final form May 28, 1992.
*See reference 2 for a complete list of investigators.
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