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(Stroke. 2002;33:1925.)
© 2002 American Heart Association, Inc.

Cochrane Corner

Low-Molecular-Weight Heparins or Heparinoids Versus Standard Unfractionated Heparin for Acute Ischemic Stroke (Cochrane Review)

Carl Counsell, MD Peter Sandercock, FRCP

From the Department of Medicine and Therapeutics (C.C.), University of Aberdeen, UK, and the Department of Clinical Neurosciences (P.S.), The University of Edinburgh, UK.

Correspondence to Prof Peter Sandercock, The University of Edinburgh, Department of Clinical Neurosciences, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK. E-mail pags@skull.dcn.ed.ac.uk

Section Editor: Graeme J. Hankey MBBS, MD

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Objectives

A systematic review of the trials directly comparing low-molecular-weight heparins (LMWH) or heparinoids with unfractionated heparin (UFH) in people with acute confirmed or presumed ischemic stroke.

Search Strategy
We searched the Cochrane Stroke Group trials register and MedStrategy (1995). We also contacted pharmaceutical companies. Date of most recent search: May 2001.

Selection Criteria
Randomized trials comparing heparinoids or LMWH with standard UFH in people with acute ischemic stroke. We included only trials in which treatment was started within 14 days of stroke onset.

Data Collection and Analysis
The 2 reviewers independently selected studies for inclusion, assessed trial quality, and extracted the data.

Main Results
We included 5 trials involving 705 people. Four trials compared a heparinoid (danaparoid), and 1 compared an LMWH (enoxaparin) with standard UFH (Figures 1 and 2). Overall, 55/414 (13%) of the patients allocated danaparoid or enoxaparin had deep vein thrombosis (DVT) compared with 65/291 (22%) of those allocated UFH. This reduction was significant (odds ratio [OR] 0.52, 95% CI 0.56 to 0.79). However, the number of more major events (pulmonary embolism, death, intracranial or extracranial hemorrhage) was too small to provide a reliable estimate of more important benefits and risks. No data on recurrent stroke or functional outcome in survivors were available.

View larger version (31K): [in this window] [in a new window]   Figure 1. Systematic review of trials comparing heparinoids or low-molecular-weight heparins with standard unfractionated heparin in people with acute ischemic stroke. Results expressed as Peto odds ratio (OR) with a fixed-effects model. OR <1 suggests low-molecular-weight heparins or heparinoid superior to unfractionated heparin. Effects on deep vein thrombosis. (Figure 01.01.00. Counsell C, . . . [Full Text of this Article]

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