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Updated: Jun 29, 2026
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Anticoagulants for acute ischaemic stroke
Peter A G Sandercock1, Carl Counsell, Ayeesha K Kamal
1Department of Clinical Neurosciences, University of Edinburgh, Neurosciences Trials Unit, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU.
The Cochrane Database of Systematic Reviews
|October 10, 2008
Summary
Early anticoagulant therapy for acute ischemic stroke does not offer significant benefits and increases bleeding risks. While it reduces recurrent strokes and pulmonary embolisms, the overall risks outweigh potential advantages, precluding routine use.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Ischemic strokes are primarily caused by cerebral artery blockages from blood clots.
- Anticoagulant therapy could potentially improve outcomes by preventing clots, but only if bleeding risks are manageable.
- This review is an updated analysis of previous Cochrane reviews on anticoagulants for stroke.
Purpose of the Study:
- To evaluate the efficacy and safety of anticoagulant therapy compared to control in acute ischemic stroke patients.
- The focus is on early treatment, defined as initiation within 14 days of stroke onset.
Main Methods:
- Conducted a systematic review of randomized controlled trials (RCTs) comparing early anticoagulant therapy with control.
- Searched major databases including the Cochrane Stroke Group Trials Register up to October 2007.
- Two independent reviewers selected trials, assessed quality, and extracted data.
Main Results:
- Twenty-four trials involving 23,748 participants were analyzed, with varying quality.
- Anticoagulants did not reduce all-cause mortality (OR 1.05; 95% CI 0.98-1.12) or death/dependency (OR 0.99; 95% CI 0.93-1.04).
- While reducing recurrent strokes (OR 0.76; 95% CI 0.65-0.88) and pulmonary emboli (OR 0.60; 95% CI 0.44-0.81), anticoagulants significantly increased intracranial (OR 2.55; 95% CI 1.95-3.33) and extracranial bleeding risks (OR 2.99; 95% CI 2.24-3.99).
Conclusions:
- Current evidence does not support the routine use of anticoagulants in acute ischemic stroke patients.
- The benefits of reducing recurrent strokes and embolisms are offset by increased risks of serious hemorrhages.
- No significant short-term or long-term net benefit was observed from immediate anticoagulant therapy.
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