Seven RCTs (n=4,624) were included.
All studies reported the method of randomisation. In 5 studies both patients and outcome assessors were blinded. Six studies reported the number of patients lost to follow-up.
There was no statistically significant difference between anticoagulant and other treatment in death or disability at final follow-up (73.5% versus 73.8%; OR 1.01, 95% CI: 0.82, 1.24, p=0.9) or all strokes (OR 1.18, 95% CI: 0.74, 1.88, p=0.49). No significant heterogeneity was found for either analysis. Anticoagulants were associated with a non significant reduction in recurrent stroke within 7 to 14 days compared with other treatments (3.0% versus 4.9%; OR 0.68, 95% CI: 0.44, 1.06, p=0.09), but were associated with a significant increase in symptomatic intracranial bleeding (2.5% versus 0.7%; OR 2.89, 95% CI: 1.19, 7.01, p=0.02; NNH =55).
Compared with placebo, anticoagulants were associated with a non significant reduction in death or disability at final follow-up (OR 0.90, 95% CI: 0.67, 1.22). Compared with aspirin, anticoagulants were associated with a non significant increase in death or disability at final follow-up (OR 1.14, 95% CI: 0.95, 1.38). There was no significant difference between anticoagulants and aspirin in pulmonary embolism (OR 0.94, 95% CI: 0.44, 2.00, p=0.87).