AN ASPIRIN A DAY TO KEEP STROKE AWAY? Emory Receives $14 Million Federal Grant to Coordinate 50-Site Brain Attack Prevention Trial

Doctors don't know how best to prevent stroke caused by clogged arteries in the brain ­ a condition known as intracranial arterial stenosis.

To better evaluate two potential tactics for preventing this type of stroke in high-risk patients, the National Institute of Neurological Disorders and Stroke of the National Institutes of Health has funded the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study.

Emory University has been awarded more than $14 million from the institute to coordinate a five-year trial during which 806 patients will be evaluated at 50 sites in North America. The Clinical Coordinating Center will be based in the Department of Neurology at the Emory University School of Medicine, the Statistical Coordinating Center in the Department of Biostatistics at the Rollins School of Public Health of Emory University and the Pharmacy Coordinating Center at Emory University Hospital.

"This year we expect more than 700,000 Americans to experience a stroke, and of these, some 40,000 will sustain stroke caused by narrowing of the intracranial arteries," says WASID Principal Investigator Marc Chimowitz, M.B., ChB, associate professor and co-director of Emory Stroke Center in the Department of Neurology at the Emory University School of Medicine. "This type of stroke disproportionately affects minorities, including African-Americans, Asians and Hispanics.

"Our primary goal will be to compare the effectiveness of two different medications, warfarin or aspirin, for preventing stroke and vascular death in persons with intracranial stenosis," Dr. Chimowitz says.

Patients who have recently had a minor stroke or transient ischemic attack (TIA, or "mini stroke"), who are eligible to participate and sign an informed consent, will be randomized to receive either aspirin or warfarin, and will be evaluated by stroke experts at the WASID study site nearest them every four months for the duration of the study.

A stroke or "brain attack" occurs when blood circulation to the brain becomes interrupted. The most common type of stroke, ischemic stroke, occurs when an artery narrows or a blood clot blocks blood flow in an artery supplying the brain. A clot can form because of sluggish blood flow through a vessel narrowed by fatty, atherosclerotic deposits. Atherosclerosis in a major artery in the brain, intracranial stenosis, is a leading contributor to ischemic stroke and TIAs, particularly in minorities.

Stroke prevention in patients with intracranial stenosis typically involves reducing risk of blood clots through use of blood-thinning medications, including aspirin, Coumadin (warfarin), Plavix (clopidogrel), Ticlid (ticlopidine) and Persantine (dipyridamole). Doctors do not know which of these medications is most effective for prevention; WASID is intended to contribute valuable information to help make that determination.