Replacing aspirin and warfarin for secondary stroke prevention: is it worth the costs?

Abstract:

PURPOSE OF REVIEW:This review aims to determine whether it is cost-effective to replace aspirin and warfarin with more effective, yet more costly, treatments for secondary stroke prevention. RECENT FINDINGS:For preventing recurrent stroke of arterial origin, clopidogrel and the combination of aspirin and extended-release dipyridamole are equally effective and more effective than aspirin. However, limited data only support their incremental cost-effectiveness, compared with aspirin, in nondisabled patients at high risk of a recurrent ischaemic event (e.g. >20% per year) and when used for short periods (e.g. <2 years). Clopidogrel is also cost-effective for patients who are intolerant of aspirin. For preventing recurrent stroke due to atrial fibrillation, warfarin is cost-effective. Although the combination of clopidogrel and aspirin is more effective than aspirin, it is unlikely to be more cost-effective. Dabigatran is at least as effective and well tolerated as warfarin, but its eventual cost will determine its incremental cost-effectiveness. For atrial fibrillation patients in whom anticoagulation is contraindicated, percutaneous closure of the left atrial appendage may be an alternative strategy. Dronedarone may prove to be a cost-effective adjunct to antithrombotic therapy in patients with atrial fibrillation. SUMMARY:The incremental cost-effectiveness of newer antithrombotic treatments for secondary stroke prevention, compared with aspirin or warfarin, remains to be established.

journal_name

Curr Opin Neurol

authors

Hankey GJ

doi

10.1097/WCO.0b013e328334e67b

subject

Has Abstract

pub_date

2010-02-01 00:00:00

pages

65-72

issue

1

eissn

1350-7540

issn

1473-6551

journal_volume

23

pub_type

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