Heparin Could Reduce Neurologic Deterioration Following Stroke

Following an acute ischemic stroke, low-molecular weight heparin (LMWH) may help prevent early neurologic deterioration in patients with large artery occlusive disease (LAOD), according to a new study.

Researchers at the Prince of Wales Hospital (Hong Kong SAR, China) conducted a post-hoc analysis of a randomized, controlled, trial involving 353 patients following acute ischemic stroke and LAOD. The patients were randomly assigned to receive either subcutaneous LMWH (180 patients) or oral aspirin (173 patients) within 48 hours after stroke onset for 10 days; following intervention, all patients received aspirin once daily for six months. The main outcome measure was the prevention of early neurologic deterioration (END) within the first 10 days after index stroke.

The analysis showed that END occurred in 12 of the heparin group patients (6.7%) and 24 of the aspirin group patients (13.9%). The 7.2 percentage point difference yielded an odds ratio of 0.44 in favor of heparin. When the researchers looked at the individual components of their endpoint, they found that stroke progression within the first 10 days was 5% with heparin and 12.7% with aspirin, leading to an odds ratio of 0.36. The rates of early recurrent ischemic stroke (ERIS) and intracranial cerebral hemorrhage were not significantly different, as were the rates of other cerebral hemorrhages, both symptomatic and asymptomatic. The study was published in the August 13, 2012, issue of Archives of Neurology.

“For patients with acute ischemic stroke and LAOD, treatment with LMWH within 48 hours of stroke may reduce END during the first 10 days, mainly by preventing stroke progression,” concluded lead author Ka Sing Lawrence Wong, MD, and colleagues. “The similar rate of cerebral hemorrhage between LMWH and aspirin demonstrated that LMWH may be safely used in acute ischemic stroke.”

Patients with acute ischemic stroke and LAOD have an increased risk for early neurologic deterioration due to progressive stroke, ERIS, or symptomatic intracranial cerebral hemorrhage (SICH). LMWH has been widely advocated to prevent venous thromboembolism, but its risks and benefits in early ischemic stroke are inadequately defined.

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