Drug Reduces Risk of Thromboembolism After Stroke

A new study shows the superiority of enoxaparin sodium over unfractionated heparin (UFH) in reducing the risk of venous thromboembolism (VTE) in patients who suffered an acute ischemic stroke.

The prevention of VTE after acute ischemic stroke with low-molecular weight heparin (LMWH) enoxaparin (PREVAIL) trial enrolled a total of 1,762 stroke patients in over 15 countries. Patients confirmed with an acute ischemic stroke were randomized within 48 hours of stroke symptoms to receive a once daily administration by injection of 40 mg of Clexane/ Lovenox (enoxaparin sodium), or 5000 units of UFH treatment twice daily for 10 days (+/- 4 days), with a follow up period of 90 days.

Results showed that enoxaparin caused a significant 43% relative risk reduction in VTE events, compared to the UFH. Importantly, the reduction in VTE risk was also observed in patients presenting with different levels of ischemic stroke severity, without significant difference in clinically important bleedings as well. The incidence of the composite of symptomatic intracranial and major extracranial hemorrhage and symptomatic intracranial hemorrhage was small, with no difference between groups. The rate of major extracranial bleeding, mainly gastrointestinal bleeding, was higher with enoxaparin, but did not lead to increased mortality. There was no difference in all-cause mortality between groups. The study was published in the April 21, 2007, edition of The Lancet.

"Enoxaparin is preferable to unfractionated heparin for venous thromboembolism prophylaxis in this high-risk medically ill patient in view of its better clinical benefits to risk ratio and convenience of once daily administration,” concluded lead author Prof. David G Sherman of the University of Texas Health Science Center (San Antonio, TX, USA), and colleagues.

Enoxaparin, made by Sanofi-aventis (Paris, France), is an anticoagulant of the LMWH class. It is used to inhibit clot formation in venous or arterial vessels to avoid potential acute or chronic complications of venous or arterial thrombosis such as pulmonary embolism, myocardial infarction (MI), or death of cardiovascular origin.


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University of Texas Health Science Center
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