Practice variation among Michigan neurologists in the use of intravenous heparin

The indications for intravenous (IV) heparin use in acute ischemic stroke are uncertain. We sought to determine the current practice patterns of neurologists in Michigan with regard to IV heparin use, in view of the fact that several major multi-center trials evaluating heparin and related compounds have been completed in the last decade.

A survey was conducted of 180 active, practicing neurologists in Michigan. Five clinical scenarios were included and factors influencing heparin use were also determined.

The vast majority of neurologists in Michigan would use IV heparin for patients with atrial fibrillation-related stroke (91% of those with a defined opinion). Heparin use was also popular for stroke-in-evolution (77%). There was a lesser degree of heparin use for patients with more than one transient ischemic attack (49%) or for patients with stroke and normal cardiac rhythm. Medicolegal factors at least sometimes influenced the selection of heparin as a therapy for 41% of physicians.

Despite recent clinical trial data on heparin and related compounds which for the most part has been negative, IV heparin use remains popular for certain clinical scenarios, especially acute stroke with atrial fibrillation. Further studies are necessary to determine whether negative clinical trials have the same impact on neurologist behavior as positive studies.