Seneca Plutarchus on Sensible Medicine

[Seneca Plutarchus]

Some additional food for thought in answering this question would be to delve into this chart of adverse reactions here:

https://www.nejm.org/doi/suppl/10.1056/NEJMoa2415120/suppl_file/nejmoa2415120_appendix.pdf - Page 41

(mirror: https://drive.google.com/file/d/1-3FNVx2liThRtZm7ZFnxrra5_9yJHMaV/view?usp=sharing)

Using a 2.2% stroke rate, with a 10% actual reduction of stroke as per the observational study you cited and extrapolating the serious adverse event rates published in that chart which appear to be about double overall in the study group compared to control:

In 100,000 patients I get a reduction of 220 strokes (2200 to 1980) in exchange for 230 more serious adverse events in the study group (579 vs 342). It would be nice to know what was involved in all the falling people appear to be doing in the intervention group, because there seems to be quite a bit of it. Just going by procedural complications (4/24 vs 1/13), I get 105 direct procedural complications per 100,000 versus 26 in the control group, for an excess of 79 versus 220 strokes prevented.

There's also about double the rate of non-serious adverse events listed in that chart as well and they are about as frequent in the study group as the serious events were, but less frequent in the control group, so there is a greater spread of non-serious adverse events as well, which is probably in the realm of another 200 or so excess adverse events on top of the serious ones.

Seems pretty marginal, depending on how serious these adverse events really are judged, but stroke is often a life altering complication so it would really depend on how severe these adverse events were if it were me making the decision.