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Various trials have compared aspirin and heparin for acute ischemic stroke, but these have been too small to clarify the relative risks and benefits of each treatment. Here, investigators from the International Stroke Trial randomized about 19,500 stroke patients to aspirin, heparin (low- and moderate-dose), both, or neither. Treatment was started within 48 hours of stroke and continued for up to 14 days. Primary end points were death within 14 days and death or dependence on others at six months.
Overall, a reduction in recurrent ischemic strokes in the heparin groups was offset by an increase in hemorrhagic stroke. No significant difference in short-term mortality was seen in the aspirin groups, but at six-month follow-up, the aspirin grou…