Anticoagulants for acute ischaemic stroke

Sandercock, Peter; Counsell, Carl; Kane, Edward J.

doi:10.1002/14651858.cd000024.pub3

Cited by 175 publications

(73 citation statements)

References 54 publications

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“…Although heparin-based anticoagulants have a weight of evidence demonstrating their benefit in preventing VTE in postoperative and medical inpatients (12)(13)(14), they are also associated with higher bleeding complication rates than are antiplatelet medication (15). Traditionally, it was argued that antiplatelet agents were ineffective as VTE prophylaxis because of the prothrombotic milieu in veins featuring platelet-independent, low-flow fibrin aggregation.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Medjeral-Thomas

Ziaj

Condon

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Venous thromboembolism (VTE) occurs in 7%-40% of nephrotic patients. The risk of VTE depends on the severity and underlying cause of nephrotic syndrome. This study investigated the use of low-dose prophylactic anticoagulation to prevent VTE in patients with nephrotic syndrome caused by primary glomerulonephritis.Design, setting, participants, & measurements Since 2006, all patients presenting with nephrotic syndrome to Imperial College Kidney and Transplant Centre have been considered for treatment with a novel anticoagulation prophylaxis regimen. All cases of nephrotic syndrome secondary to primary membranous nephropathy, minimal-change disease, and FSGS over a 5-year period were retrospectively reviewed. Patients with serum albumin,2.0 g/dl received prophylactic-dose low-molecular-weight heparin or low-dose warfarin; patients with albumin levels of 2.0-3.0 g/dl received aspirin, 75 mg once daily. All thrombotic events and bleeding complications were recorded.Results A total of 143 patients received the prophylactic anticoagulation regimen. Median follow-up was 154 weeks (range, 30-298 weeks). The cohort had features associated with a high risk of developing VTE; 40% of the cohort had an underlying diagnosis of membranous nephropathy, and the initial median serum albumin was 1.5 g/dl (range, 0.5-2.9 g/dl). No VTE occurred in patients established on prophylaxis for at least 1 week. VTE was diagnosed in 2 of 143 patients (1.39%) within the first week after presentation and starting prophylaxis. In both cases, it is unclear whether the thrombus had developed before or after the start of prophylaxis. One of 143 (0.69%) patients receiving prophylaxis was admitted urgently with gastrointestinal hemorrhage. Two of 143 patients (1.40%) had elective blood transfusions and procedures to manage occult gastrointestinal bleeding. No other bleeding events occurred in patients receiving prophylaxis.Conclusions This regimen of prophylactic antiplatelet or anticoagulant therapy appears effective in preventing VTE in nephrotic syndrome, with relatively few hemorrhagic complications.

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Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Medjeral-Thomas

Ziaj

Condon

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Both conditions have a narrow therapeutic time-window, such that acute management of one at the expense of the other may result in permanent irreversible disability from the infarcted area that received delayed intervention. In addition, the use of antiplatelet and anticoagulants that are inherently part of a percutaneous coronary intervention (PCI) for AMI may increase the risk for hemorrhagic conversion associated with intravenous thrombolysis (3,4), and the use of a thrombolytic in AIS increases the risk of cardiac wall rupture in the setting of AMI (5). In fact, according to the guidelines for the early management of patients with AIS, AMI within the past 3 months is considered a relative contraindication to the use of a thrombolytic (Class IIb, level of evidence C) (6).…”

Section: Introductionmentioning

confidence: 99%

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

et al. 2018

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Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) are both life-threatening medical conditions with narrow therapeutic time-window that carry grave prognosis if not addressed promptly. The acute management of both condition is well documented in the literature, however the management of a simultaneous presentation of both AIS and AMI is unclear. A delayed intervention of one infarcted territory for the other may result in permanent irreversible morbidity or disability, and even death. In addition, the use of antiplatelet and anticoagulants that are inherently part of an AMI management may increase the risk for hemorrhagic conversion associated with intravenous thrombolysis used in AIS, and the use of a thrombolytic in AIS increases the risk of cardiac wall rupture in the setting of an AMI.Despite this ambiguity, there is no clear evidence-based guideline or clinical studies that have addressed the optimal management of this rare co-occurrence. This review paper examines the existing literature on the management of simultaneous acute cardio-cerebral infarction (CCI) and highlights the existing challenge to management.

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“…ASA/AHA or ESO stroke guidelines do not recommend heparin or its derivates for the treatment of acute ischemic stroke [20][21] . These recommendations reflect the results of large clinical studies and meta-analyses 12,17,19 . Unfortunately, in most published clinical studies, heparin or LMWH were used later than 24 h from the onset of a stroke.…”

Section: Discussionmentioning

confidence: 84%

“…This is due especially to the results of several clinical studies, showing that there is a higher incidence of hemorrhagic complications, especially hemorrhagic transformation of ischemic tissue in patients treated with LMWH or heparin [12][13][14][15][16][17][18][19] . The use of heparin or LMWH is thus, according to current guidelines, accepted only as a prophylaxis for deep venous thrombosis.…”

Section: Introductionmentioning

confidence: 99%

The safety and efficacy of Heparin and Nadroparin compared to placebo in acute ischemic stroke - pilot study

Dluha¹,

Sivák²,

Kurča³

et al. 2016

BIOMED PAP

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Aims. This study aimed to compare the efficacy and safety of heparin and nadroparin in order to provide an additional therapeutic option for patients with acute ischemic stroke in, whom systemic thrombolysis was excluded, or thrombectomy could not be performed. Methods. We describe a prospective randomized double-blind placebo-controlled pilot study in acute ischemic stroke. The therapeutic window was between 4.5 and 24 h after the onset of stroke. During the first 24 h of treatment, the patients divided into 3 groups received placebo, heparin or nadroparin (in therapeutic doses). During the following 48 h, each patient received nadroparin in the therapeutic dose. 24 h after start of treatment they began taking 100 mg aspirin daily. The primary safety indicator was incidence of complications such as intracerebral or systemic hemorrhage, or death. Efficacy was primarily monitored by the neurological modified Rankin Scale (mRS) at 90 days.Results. There were no signs of intracerebral or systemic bleeding in the cohort of 87 patients. Two patients died -one (3.7%) in the heparin and one (3.8%) in the placebo group due to causes not connected with the treatment. There was a statistically significant difference in mRS on the 90 th day between the heparin and placebo groups (21 (80%) vs 13 (50%), P=0.0350) and between the nadroparin and placebo groups (29 (85%) vs 13 (50%), P=0.0031). Conclusion.The results show that the treatment with heparin and nadroparin is safe and effective. Trial registration: Trial is registered in ClinicalTrials.gov: NCT01862978.

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Anticoagulants for acute ischaemic stroke

Cited by 175 publications

References 54 publications

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

The safety and efficacy of Heparin and Nadroparin compared to placebo in acute ischemic stroke - pilot study

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