Heparin anticoagulation in acute brain ischemia.

Miller, Vincent T.; Hart, Robert G.

doi:10.1161/01.str.19.3.403

Cited by 34 publications

(19 citation statements)

References 29 publications

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“…Some physicians have advised that heparin not be given to patients with arterial hypertension, an altered level of consciousness, or large hemispheric infarcts of cardioembolic origin because such patients appear to be at high risk of hemorrhagic transformation. The incidence of hemorrhage in our study was lower than that among patients given heparin 17 and should also be compared with the reportedly high incidence of spontaneous hemorrhagic transformation following ischemic stroke. However, our results suggest caution in the use of ORG 10172 in patients with major hemispheric infarcts secondary to cardioembolism, particularly if the patient has severe hypertension (MABP of > 130 torr).…”

Section: Resultscontrasting

confidence: 52%

Large-dose infusions of heparinoid ORG 10172 in ischemic stroke.

Massey

Biller

Davis

et al. 1990

Stroke

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We evaluated the safety and possible efficacy of large doses of the heparinoid ORG 10172 in 57 patients with acute or progressing ischemic stroke. Patients received a loading bolus of the drug followed by a maintenance intravenous infusion for 7 days. The plasma level of ORG 10172 was monitored by the degree of inhibition of coagulation factor Xa. In general, the drug was well tolerated and few hemorrhagic complications occurred. Two patients with large cardioembolic hemispheric strokes had intracranial hemorrhagic complications. Most patients improved during treatment. By 3 months after the stroke, 37 patients (65%) had a favorable outcome (minimal or no residual disability). This study suggests that high-dose intravenous infusions of ORG 10172 can be safely given to patients with acute ischemic stroke. (Stroke 1990;21:1289-1292) B ecause the treatment of stroke patients with heparin is associated with hazardous hemorrhagic complications, 12 there has been an ongoing search for safer antithrombotic preparations.3 -7 Recently developed preparations have allowed a dissociation of the antithrombotic activity of heparin from its anticoagulant and plateletaggregating effects. Low-molecular-weight heparinoids have strong selective anti-factor Xa activity but weak antithrombin activity and a negligible anticoagulant effect. These preparations offer an alternative therapy with a decreased bleeding tendency.

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Section: Resultscontrasting

confidence: 52%

Large-dose infusions of heparinoid ORG 10172 in ischemic stroke.

Massey

Biller

Davis

et al. 1990

Stroke

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“…While established methods for prevention of ischemic stroke exist – treatment with antiplatelets, oral anticoagulants or carotid endarterectomy [35] — there is no established specific anticoagulant treatment for acute episodes that has shown reduction in mortality or improvement in functional status [36,37]. Anticoagulant agents, including heparin, have been given for decades, but their benefits are unproven and their use therefore remains controversial [38,39,40]. If anticoagulants are used in patients with stroke, there is the worry of increasing the likelihood of intracranial hemorrhage, thereby worsening the prognosis.…”

Section: Lmwhs In the Treatment Of Acute Strokementioning

confidence: 99%

Arterial indications for the low molecular weight heparins

Ageno

Huisman

2001

Trials

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Antithrombotic treatment is of proven importance in patients with acute coronary syndromes. There is now accumulating evidence from several clinical trials in patients with unstable angina pectoris that the low molecular weight heparins (LMWHs) are at least as effective as unfractionated heparin. The LMWHs are easier to use, with the potential to facilitate long-term outpatient treatment. The results of the trials have actually failed to show any clear advantage, however, of the LMWHs over the standard antiplatelet treatment, despite the evidence of a sustained hypercoagulability. Potentially, the use of higher doses of LMWHs could improve the outcomes, but this is as yet unproven and could be associated with unacceptably increased risk of bleeding. During the acute phase of a stroke, aspirin is the first choice of antithrombotic drug because it reduces the risk of recurrent stroke. LMWH cannot be recommended as an antithrombotic agent for the acute treatment of stroke. Prophylactic use of low dose LMWH for the prevention of venous thromboembolism should be considered in every patient with a stroke.

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“…6,7 Currently, heparin is mainly used to prevent stroke recurrence in patients with cardiac arrhythmia or ventricular dyskinesia8-10 after 48 hours from the event in case of a small nonhemorrhagic infarct on CT.11 Its role in the treatment of stroke-in-evolution or in the prevention of carotid occlusion remains controversia1.12,13 It is essential that a CT-documented brain hemorrhage prior to anticoagulation has to be excluded. Unlike thrombolysis, anticoagulation with heparin cannot dissolve the thrombus.…”

Section: Management-treatment Of the Thromboembolic Strokementioning

confidence: 99%

Stroke: Management and Rehabilitation

2000

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The aim of this review is to present the current knowledge regarding stroke. It appears in three parts (in part I the epidemiology, clinical picture, and risk factors were discussed, while part II dealt with the pathogenesis, investigations, and prognosis). In this part (III) the management is presented. In an acute stroke the role of the following is discussed in detail: Thrombolysis, anticoagulant agents, and prophylactic neuroprotection with pharmacologic agents. For the prevention of stroke apart from the risk factors, which were presented in part I, the current knowledge with pharmacologic agents is discussed. Also the role of carotid endarterectomy, extracranial-intracranial bypass surgery, carotid artery angioplasty and stenting, and the treatment of cerebral hemorrhage are described. Finally the means and possibilities of rehabilitation are discussed.

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Heparin anticoagulation in acute brain ischemia.

Cited by 34 publications

References 29 publications

Large-dose infusions of heparinoid ORG 10172 in ischemic stroke.

Large-dose infusions of heparinoid ORG 10172 in ischemic stroke.

Arterial indications for the low molecular weight heparins

Stroke: Management and Rehabilitation

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