This Article Full Text Full Text (PDF) All Versions of this Article: 36/9/2045    most recent 01.STR.0000176587.45249.50v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hankey, G. J. Articles by Stobbs, S.L. Search for Related Content PubMed Articles by Hankey, G. J. Articles by Stobbs, S.L. Related Collections Deep vein thrombosis Heparin Other anticoagulants Acute Cerebral Infarction Anticoagulants

(Stroke. 2005;36:2045.)
© 2005 American Heart Association, Inc.

Cochrane Corner

Low-Molecular-Weight Heparins or Heparinoids Versus Standard Unfractionated Heparin for Acute Ischemic Stroke

From the Department of Clinical Neurosciences (P.S., S.L.S.), Neurosciences Trials Unit, University of Edinburgh; and University of Aberdeen (C.C.), UK.

Correspondence to Prof Peter A.G. Sandercock, Dept of Clinical Neurosciences, University of Edinburgh, Neurosciences Trials Unit, Bramwell Dott Bldg, Western General Hospital, Crewe Rd, Edinburgh EH4 2XU, UK. E-mail Peter.Sandercock@ed.ac.uk

Key Words: acute stroke • brain infarction • hemorrhage, intracranial • heparin

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

	Introduction

 
Low-molecular-weight heparins (LMWHs) and heparinoids are anticoagulants that may be associated with lower risks of hemorrhage and more powerful antithrombotic effects than standard unfractionated heparin (UFH).

	Objectives

 
The objective of this review was to compare the effects of LMWHs or heparinoids with those of UFH in people with acute, confirmed, or presumed ischemic stroke.

	Search Strategy

 
We searched the Cochrane Stroke Group trials register (last searched November 2003). In addition, we searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2003, Issue 4), MEDLINE (1966 to October 2003), and EMBASE (1980 to October 2003).

	Selection Criteria

 
Randomized trials comparing heparinoids or LMWHs with standard UFH in people with acute ischemic stroke. Only trials where treatment was started within 14 days of stroke onset were included.

	Data Collection and Analysis

 
Two reviewers independently selected studies for inclusion, assessed trial quality, and extracted the data.

	Main Results

 
Six trials involving 740 people were included. Four trials compared a heparinoid (danaparoid), 1 trial compared a LMWH (enoxaparin), and 1 trial compared an unspecified LMWH with standard UFH. Allocation a to LMWH or heparinoid was associated with a significant reduction in the odds of deep vein thrombosis (Peto odds ratio, 0.52; 95% CI, 0.56 to 0.79). However, the number of more major events (pulmonary embolism [PE], death, intracranial, or extracranial hemorrhage) was too small to provide a reliable estimate of more important benefits and risks. No information was reported for recurrent stroke or functional outcome.

	Reviewers’ Conclusions

 
Treatment with a LMWH or heparinoid after acute ischemic stroke appears to decrease the occurrence of deep vein . . . [Full Text of this Article]