Stroke, Vol 14, 668-676, Copyright © 1983 by American Heart Association
A randomized trial of immediate versus delayed anticoagulation of patients
with cardiogenic embolic brain infarction was carried out in a
multi-centered study. Patients who were within 48 hours of onset of deficit
and who had no evidence of hemorrhage on computed tomography (CT) were
randomized to receive either immediate heparinization or no anticoagulants
for the initial 14 days following stroke. There were 63 patients with
embolic stroke identified during the study period. Eighteen patients were
not randomized because of specific exclusion criteria or delayed
identification more than 48 hours after stroke. Of 45 patients who were
randomized, 44 patients (98%) completed the initial week of the protocol:
24 were immediately heparinized at an average of 32 hours after stroke, 21
received no immediate anticoagulation. Two patients developed delayed
hemorrhagic infarction and two patients experienced early recurrent
embolism, all among the nonanticoagulated group. Of all patients with
embolic stroke who were not receiving coumadin at onset of stroke, only two
of 56 (4%) had hemorrhagic infarction on initial CT. Follow-up CT in 40 of
these patients showed late developing hemorrhagic infarction in two
additional patients (5%). All four hemorrhagic infarctions occurred in 18
non-anticoagulated patients with large infarcts. There were no major
complications associated with immediate heparinization of 24 unselected
patients with all sizes of embolic infarction. A trend toward reduction of
early recurrent embolism was apparent. These data support immediate
anticoagulation of nonhypertensive patients with embolic brain infarction
who have no evidence of hemorrhage on CT performed 24-48 hours after
stroke.
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