Abstract 3370: Symptomatic Intracranial Haemorrhage And Heparin: Interrelation Between Dose, Timing And Stroke Severity In The International Stroke Trial (ist)
Background: Heparin increases the risk of haemorrhagic transformation following acute cerebral infarction but the relationships to dose and timing of treatment is unclear.
Method: The relationship between symptomatic intracerebral haemorrhage (SICH), heparin dose and timing, and patient factors were explored with data from the International Stroke Trial. This study was a factorial randomised controlled trial of subcutaneous heparin (given twice daily as 5,000 or 12,500 iu), aspirin (300 mg daily), both, or neither started within 48 hours and given for up to 14 days after acute ischaemic stroke. Of 19,435 randomised patients, 17,398 with CT-confirmed ischaemic stroke were included in the present analysis. Multiple variable analyses were adjusted for age, sex, severity (number of neurological impairments, 0-8), heparin dose, aspirin treatment and time to randomisation (as a surrogate for time to treatment).
Results: SICH occurred in 122 (0.7%) of patients within 14 days of randomization and peaked on day 1 post-randomisation. SICH was associated, in univariate analyses, with younger age (odds ratio, OR 0.98, 95% confidence intervals, CI 0.97-0.99), male sex (OR 1.52, 95% CI 1.05, 2.20), severe stroke (OR 1.49 per impairment, 95% CI 1.29, 1.71) and medium dose heparin (OR 4.93, 95% CI 3.20, 7.61), and inversely with time to randomisation (OR 0.97, 95% CI 0.95-0.98). In multiple variable analysis, SICH remained associated with the same factors, in particular severe stroke (OR 1.49, 95% CI 1.29, 1.72) and medium dose heparin (OR 4.97, 95% CI 3.22, 7.67), and inversely with time to randomisation (OR 0.97, 95% CI 0.96-0.99).
Conclusion: The risk of SICH increased with severity of stroke, heparin dose and a short time from stroke to treatment. The potential risk of SICH with early anticoagulation should be considered if heparin therapy is required in patients with acute ischaemic stroke.
- © 2012 by American Heart Association, Inc.