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[Heparin during acute ischemic stroke. Present data and clinical situation].
M Daffertshofer1, E Grips, C E Dempfle
1Neurologische Klinik, Universitätsklinikum Mannheim, Ruprecht-Karls-Universität, Heidelberg. daffertshofer@neuro.ma.uni-heidelberg.de
Der Nervenarzt
|April 23, 2003
Summary
Despite clinical trials showing no benefit, heparin therapy remains common in German stroke units for acute stroke patients. Most units use full-dose heparin for selected patients and low-dose heparin for thrombosis prevention, deviating from guidelines.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Clinical trials (>20) have not demonstrated statistically significant benefits of low- or high-dose heparin therapy for improving clinical outcomes (death, functional status) in acute stroke.
- Existing evidence does not support heparin's use for preventing secondary embolic events or venous thrombosis in acute stroke patients.
- Current reviews and therapy recommendations generally advise against using high-dose heparins for outcome improvement or secondary event prevention, and low-dose heparin for venous thrombosis prophylaxis.
Purpose of the Study:
- To review the existing literature on heparin therapy in acute stroke.
- To present data from a standardized survey on coagulation therapy practices in German stroke units.
- To compare current clinical practice with evidence-based treatment recommendations.
Main Methods:
- Literature review on heparin therapy in acute stroke.
- Standardized survey conducted across 33 university and major stroke units in Germany.
- Data collection on heparin agent, dosage, and patient selection criteria for anticoagulation therapy.
Main Results:
- Contrary to recommendations, heparin therapy is widely established in German stroke units.
- 97% of surveyed stroke units use full-dose heparin for selected acute stroke patients, with varying selection criteria.
- Nearly all (97%) German stroke units routinely use low-dose heparin for venous thrombosis and pulmonary embolism prophylaxis, with diverse heparin agents and dosages.
Conclusions:
- Clinical practice in German stroke units, similar to the USA and Canada, deviates significantly from evidence-based treatment recommendations for heparin use in acute stroke.
- This discrepancy may stem from individual pathophysiological considerations and low acceptance of randomized trial recommendations.
- There is a need for new research concepts, such as observational trials and continuous registries, to bridge the gap between study conditions and complex daily clinical practice, considering risk/benefit, safety, and economic factors.