This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Adams, H. P. Search for Related Content PubMed PubMed Citation Articles by Adams, H. P., Jr Related Collections Acute Cerebral Infarction Emergency treatment of Stroke Anticoagulants

(Stroke. 2002;33:856.)
© 2002 American Heart Association, Inc.

Progressive Review

Emergent Use of Anticoagulation for Treatment of Patients With Ischemic Stroke

Harold P. Adams, Jr, MD

From the Department of Neurology, University of Iowa College of Medicine, Iowa City.

Correspondence to Harold P. Adams, Jr, MD, Department of Neurology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242. E-mail harold-adams{at}uiuowa.edu

Abstract

Background— Several clinical trials have tested the potential utility of emergent anticoagulation for acute ischemic stroke.

Summary of Review— Rather than performing a meta-analysis that combines the data from several trials, this review focuses on individual studies. Although these trials do have inherent limitations, they demonstrate that emergent use of an anticoagulant is associated with a modest but significantly increased risk of hemorrhagic transformation of the ischemic stroke or serious nonneurological bleeding. The trials do not demonstrate a benefit from emergent anticoagulation in improving outcome, reducing mortality, and preventing early recurrent stroke.

Conclusions— These results suggest that most patients with acute stroke should not be treated with unfractionated heparin or other rapidly acting anticoagulants after stroke. Prevention of deep vein thrombosis and pulmonary embolism among bedridden patients is the only established indication for early anticoagulation after acute ischemic stroke.

Key Words: anticoagulants • heparin • recurrence • stroke

This article has been cited by other articles:

				G. W. Albers, P. Amarenco, J. D. Easton, R. L. Sacco, and P. Teal Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 630S - 669S. [Abstract] [Full Text] [PDF]

				L. B. Goldstein Acute Ischemic Stroke Treatment in 2007 Circulation, September 25, 2007; 116(13): 1504 - 1514. [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]

				M. Paciaroni, G. Agnelli, S. Micheli, and V. Caso Efficacy and Safety of Anticoagulant Treatment in Acute Cardioembolic Stroke: A Meta-Analysis of Randomized Controlled Trials Stroke, February 1, 2007; 38(2): 423 - 430. [Abstract] [Full Text] [PDF]

				M. J. O'Donnell, E. Berge, and P. M. Sandset Are There Patients With Acute Ischemic Stroke and Atrial Fibrillation That Benefit From Low Molecular Weight Heparin? Stroke, February 1, 2006; 37(2): 452 - 455. [Abstract] [Full Text] [PDF]

				M. Camerlingo, P. Salvi, G. Belloni, T. Gamba, B. M. Cesana, and A. Mamoli Intravenous Heparin Started Within the First 3 Hours After Onset of Symptoms as a Treatment for Acute Nonlacunar Hemispheric Cerebral Infarctions Stroke, November 1, 2005; 36(11): 2415 - 2420. [Abstract] [Full Text] [PDF]

				P. M.W. Bath, L. Zhao, and S. Heptinstall Current status of stroke prevention in patients with atrial fibrillation Eur. Heart J. Suppl., May 1, 2005; 7(suppl_C): C12 - C18. [Abstract] [Full Text] [PDF]

				H. Adams, R. Adams, G. Del Zoppo, and L. B. Goldstein Guidelines for the Early Management of Patients With Ischemic Stroke: 2005 Guidelines Update A Scientific Statement From the Stroke Council of the American Heart Association/American Stroke Association Stroke, April 1, 2005; 36(4): 916 - 923. [Full Text] [PDF]

				H. P. Adams Jr Effective Prophylaxis for Deep Vein Thrombosis After Stroke: Low-Dose Anticoagulation Rather Than Stockings Alone: For Stroke, December 1, 2004; 35(12): 2911 - 2912. [Full Text] [PDF]

				G. W. Albers, P. Amarenco, J. D. Easton, R. L. Sacco, and P. Teal Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 483S - 512S. [Abstract] [Full Text] [PDF]

				P H Lee, S H Oh, O Y Bang, I S Joo, and K Huh Isolated middle cerebral artery disease: clinical and neuroradiological features depending on the pathogenesis J. Neurol. Neurosurg. Psychiatry, May 1, 2004; 75(5): 727 - 732. [Abstract] [Full Text] [PDF]

				R. Gupta, H.C. Schumacher, S. Mangla, P.M. Meyers, H. Duong, A.G. Khandji, R.S. Marshall, J.P. Mohr, and J. Pile-Spellman Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis Neurology, December 23, 2003; 61(12): 1729 - 1735. [Abstract] [Full Text] [PDF]

				S. C. Johnston and J. D. Easton Are Patients With Acutely Recovered Cerebral Ischemia More Unstable? Stroke, October 1, 2003; 34(10): 2446 - 2450. [Abstract] [Full Text] [PDF]

				A. S. Packard, C. S. Kase, A. S. Aly, and G. D. Barest "Computed Tomography-Negative" Intracerebral Hemorrhage: Case Report and Implications for Management Arch Neurol, August 1, 2003; 60(8): 1156 - 1159. [Abstract] [Full Text] [PDF]

				E. Grips, M. Daffertshofer, M. Hennerici, and H. P. Adams Jr Banning Anticoagulation in Stroke or Consequence of Poor Study Design Stroke, April 1, 2003; 34 (4): 837 - 839. [Full Text] [PDF]

				M. Castellanos, R. Leira, J. Serena, J. M. Pumar, I. Lizasoain, J. Castillo, A. Davalos, and G. F. Hamann Plasma Metalloproteinase-9 Concentration Predicts Hemorrhagic Transformation in Acute Ischemic Stroke * Editorial Comment Stroke, January 1, 2003; 34(1): 40 - 46. [Abstract] [Full Text] [PDF]

				G. Y H Lip, S. Kamath, and R. G Hart ABC of antithrombotic therapy: Antithrombotic therapy for cerebrovascular disorders BMJ, November 16, 2002; 325(7373): 1161 - 1163. [Full Text] [PDF]

				M. J. Alberts, J.D. Easton, G. W. Albers, and P. Amarenco Clopidogrel Plus Aspirin for Stroke Prevention Stroke, November 1, 2002; 33(11): 2546 - 2547. [Full Text] [PDF]

				Emergent Anticoagulation for Ischemic Stroke: A Review Journal Watch Neurology, May 23, 2002; 2002(523): 2 - 2. [Full Text]