This Article Full Text Full Text (PDF) All Versions of this Article: 34/1/231    most recent 01.STR.0000047037.38062.24v1 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 Sandercock, P. Search for Related Content PubMed PubMed Citation Articles by Sandercock, P. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Blood Thinners Stroke Hazardous Substances DB HEPARIN

(Stroke. 2003;34:231.)
© 2003 American Heart Association, Inc.

Controversies in Stroke

Full Heparin Anticoagulation Should Not Be Used in Acute Ischemic Stroke

From the Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.

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

Key Words: anticoagulants • heparin • stroke, ischemic

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

Unfractionated heparin was first used in clinical practice more than 50 years ago, at a time when medicinal products did not require a license.¹ Have the randomized trials performed since then reliably shown that full anticoagulation with intravenous (IV) unfractionated heparin (UFH) or IV heparinoid does more good than harm? No. If the available evidence on IV heparin in acute ischemic stroke were submitted to the FDA today, would it get a license for acute stroke? I think not.

Some experts recommend full-dose IV UFH for acute cardioembolic stroke, stroke due to carotid dissection, progressing stroke, and basilar thrombosis. What evidence is there for each of these? There have been 2 small randomized trials of full-dose IV UFH versus control (with a total of 270 patients); 1 in cardioembolic stroke and 1 in stable partial noncardioembolic ischemic stroke.^2–4 The data from the trials did not provide evidence of net benefit either separately or combined in a meta-analysis.^2–4 A Cochrane systematic review of the studies in carotid dissection found no randomized trials and concluded that the nonrandomized studies did not show any clear advantage of anticoagulants over aspirin.⁵ No randomized trials have been conducted in patients with basilar thrombosis.² There are 2 additional small trials comparing full-dose IV unfractionated heparin with other agents: 1 compared full-dose IV UFH with aspirin (the interim results were inconclusive and the trial continues)⁶; another compared subcutaneous low-molecular-weight heparin with IV UFH and was also inconclusive, with no evidence of an effect on stroke progression.⁷

. . . [Full Text of this Article]

This article has been cited by other articles:

				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. Benatar Heparin use in acute ischaemic stroke: does evidence change practice? QJM, February 1, 2005; 98(2): 147 - 152. [Full Text] [PDF]

				W-P. Schmidt, P. Heuschmann, D. Taeger, H. Henningsen, H-J. Buecker-Nott, and K. Berger Determinants of IV heparin treatment in patients with ischemic stroke Neurology, December 28, 2004; 63(12): 2407 - 2409. [Abstract] [Full Text] [PDF]