stroke prevention

A recent clinical trial studied the efficacy and safety of two medications used for stroke prevention: Xarelto and Aspirin.

A stroke is similar to a heart attack but instead of occurring in the heart it occurs in the brain. A stroke causes a loss of blood flow to an area of the brain. The disruption of blood flow occurs because a blood clot has traveled to the brain where it eventually blocks a blood vessel. A loss of blood flow in the brain can have many negative outcomes depending on where the stroke occurs.

As we age, our stroke risk increases. Patients with high blood pressure, diabetes, high cholesterol and other medical conditions are also at an increased risk of having a stroke. Two different types of medications can be used for stroke prevention: anticoagulants and antiplatelets. These drugs are commonly known as blood thinners.

Strokes due to unknown reasons are difficult to prevent

About 20% of strokes are caused by unknown reasons. These types of strokes are difficult to prevent. Researchers at the David Braley Cardiac Vascular, and Stroke Research Institute in Hamilton, Canada, conducted a study to evaluate the efficacy of an anticoagulant, Xarelto, versus an antiplatelet medication, low dose aspirin, for stroke prevention. The results of this study were published in the New England Journal of Medicine.

Study stopped early due to potential risks

Recruited patients, who already had a stroke with no determined cause, were randomly assigned to receive either Xarelto or Aspirin. The researchers studied the efficacy of the drugs to prevent another stroke, blood clot formation, heart attack, and death. Researchers also studied the safety of the two drugs in each group of patients. Unfortunately, the study had to be stopped before the researchers could complete the evaluation because of the potential risks to the patients. A high bleeding risk in the Xarelto group and a low benefit of stroke prevention in the Aspirin group forced the researchers to end their study.

Xarelto is not better at preventing strokes than low-dose Aspirin for strokes with unknown cause

The results from the study indicate that in patients with a history of stroke of an unknown cause Xarelto was not better at preventing a stroke than low dose Aspirin. Xarelto, the anticoagulant, was associated with a higher risk of bleeding. There was no increased benefit of taking Xarelto for preventing blood clots, heart attacks, and death.

Xarelto, at a dose of 15 mg, was not more effective than low dose Aspirin for stroke prevention in patients with a history of stroke with an unknown cause. Further studies are required to determine if other anticoagulant medications are more effective than Aspirin for stroke prevention.

Written by Jessica Caporuscio, PharmD

Reference: Hart RG, Sharma M, Mundl H, et al. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. N Engl J Med. 2018.

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