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Natural history of progressive ischemic stroke in a population treated with heparin
Insights
Heparin treatment for progressive stroke showed limited benefit, with many patients experiencing deterioration or bleeding complications. Clinical factors and anticoagulation levels did not predict outcomes, suggesting current management practices may not need adjustment based on these variables.
Area of Science:
- Neurology
- Cardiovascular Medicine
Background:
- Limited data exists on the acute natural history of progressive stroke, particularly concerning heparin treatment.
- Understanding patient outcomes during acute progressive stroke is crucial for effective management.
Purpose of the Study:
- To define the acute course of patients treated with heparin for progressive stroke.
- To identify clinical or laboratory variables associated with further deterioration or hemorrhagic complications.
Main Methods:
- Retrospective chart review of 69 patients with progressive stroke treated with heparin.
- Analysis of clinical features, laboratory variables, and heparin dosing regimens.
- Correlation of clinical progression and hemorrhage with anticoagulation levels (partial thromboplastin time).
Main Results:
- 36% of patients continued to deteriorate despite heparin treatment.
- 3% worsened due to intracerebral hemorrhage, and 14% experienced bleeding complications.
- No clinical features, heparin dosing, or anticoagulation levels (partial thromboplastin time) correlated with improved outcomes or predicted complications.
Conclusions:
- Current data does not provide unequivocal evidence of heparin's ineffectiveness for progressive stroke.
- Clinical decisions regarding heparin use should not be based on patient age, sex, or stroke vascular distribution.
- Frequent partial thromboplastin time adjustments may be unnecessary as they do not correlate with patient outcomes.
Abstract:
Data on the acute natural history of progressive stroke with or without heparin treatment are limited. To define the acute course of patients treated with heparin for progressive stroke, we examined the charts of 69 such patients identified through the Cornell Neurology Database from October 1979 to June 1985. Analysis included determining whether further clinical deterioration or hemorrhagic complications were associated with readily identifiable clinical or laboratory variables. Twenty-five patients (36%) continued to deteriorate while receiving heparin, another two (3%) worsened due to intracerebral hemorrhage, and a total of 10 patients (14%) had bleeding complications. No clinical features or heparin dosing regimens distinguished the patients likely to benefit from heparin. Clinical progression or hemorrhage did not correlate with the level of anticoagulation as measured by the average heparin dose per day or the mean partial thromboplastin time. Without unequivocal evidence demonstrating heparin's ineffectiveness for progressive stroke, many clinicians managing such patients will continue to use heparin. Our results suggest that this decision should not be governed by such clinical features as a patient's age or sex or by the vascular distribution of the stroke. Furthermore, frequent measurement of and overzealous efforts to adjust the partial thromboplastin time may be unnecessary since it does not correlate with outcome.