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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Anticoagulants for acute ischaemic stroke

G Gubitz, P Sandercock, C Counsell

    The Cochrane Database of Systematic Reviews
    |July 22, 2004
    PubMed

    Insights

    Early anticoagulant therapy for acute ischaemic stroke does not improve patient survival or reduce disability. While it may decrease recurrent strokes and blood clots like pulmonary embolism, it increases risks of bleeding, showing no overall net benefit.

    Area of Science:

    • Neurology
    • Cardiovascular Medicine
    • Pharmacology

    Background:

    • Ischaemic strokes are primarily caused by cerebral artery blood clots.
    • Anticoagulant therapy is a potential strategy for preventing clot formation, impacting stroke survival and recurrence.

    Purpose of the Study:

    • To evaluate the efficacy of early anticoagulant therapy versus control in acute ischaemic stroke patients.
    • To assess the net benefit of anticoagulants considering both positive and negative clinical outcomes.

    Main Methods:

    • Systematic review of randomized controlled trials comparing early anticoagulant therapy (within two weeks of stroke onset) with control.
    • Searched Cochrane Stroke Group trials register and consulted relevant databases and drug companies.
    • Independent selection, quality assessment, and data extraction by two reviewers.

    Main Results:

    • Twenty-two trials with 23,547 patients were analyzed; trial quality varied.
    • No evidence found that anticoagulants reduced all-cause mortality or death/dependency at follow-up.
    • Anticoagulants reduced recurrent ischaemic strokes and pulmonary emboli but increased symptomatic intracranial and major extracranial haemorrhages, with no net benefit identified.

    Conclusions:

    • Early anticoagulant therapy in acute ischaemic stroke offers no significant short- or long-term net benefit.
    • Current data do not support the routine use of any anticoagulant for acute ischaemic stroke.
    • While anticoagulants reduce deep vein thrombosis and pulmonary embolism risk, these benefits are outweighed by increased bleeding risks and may be managed through alternative methods.
    Abstract

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