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Heparin and heparinoids in stroke
1Division of Neurology, University of Texas Health Science Center at San Antonio, 78284-7883, USA.
Neurology
|September 23, 1998
Summary
Heparin and related anticoagulants show unclear benefits for acute ischemic stroke, despite risks like bleeding. Low-molecular-weight heparins (LMWHs) offer advantages but clinical trial results remain variable.
Area of Science:
- Neurology
- Hematology
- Pharmacology
Background:
- Heparin is widely used for deep venous thrombosis prevention and management.
- Its efficacy and safety in acute ischemic stroke and transient ischemic attack are not well-established.
- Heparin carries risks including unpredictable effects, bleeding, and thrombocytopenia.
Purpose of the Study:
- To evaluate the clinical utility of heparin, low-molecular-weight heparins (LMWHs), and heparinoids in acute ischemic stroke.
- To assess the benefits and risks of these anticoagulants in stroke treatment and prevention of recurrent events.
Main Methods:
- Review of recent large, controlled clinical trials investigating heparin, LMWHs, and heparinoids in acute ischemic stroke.
- Analysis of outcomes including mortality, disability at 6 months, and bleeding complications.
Main Results:
- One of three major trials showed a net benefit for LMWH treatment within 48 hours of stroke.
- The International Stroke Trial found heparin increased bleeding complications without clinical benefit.
- Interim analysis of the TOAST study also indicated excess bleeding with no stroke outcome benefit.
Conclusions:
- The value of heparin, LMWHs, and heparinoids in acute ischemic stroke management remains uncertain.
- Their role in recurrent stroke prevention and treatment of stroke-in-progress requires further investigation.
- Ongoing studies on LMWHs and heparinoids may clarify their appropriate use in stroke patients.