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Heparin and heparinoids in stroke

D G Sherman1

  • 1Division of Neurology, University of Texas Health Science Center at San Antonio, 78284-7883, USA.

Neurology
|September 23, 1998
PubMed
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.

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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.

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