Low-molecular-weight heparin compared with aspirin for the treatment of acute ischaemic stroke in Asian patients with large artery occlusive disease: a randomised study

Wong, Ka Sing; Chen, Christopher; Ng, Ping Wing; Tsoi, Tak Hong; Li, Ho Lun; Fong, Wing Chi; Yeung, Jonas; Wong, Chi Keung; Yip, Kin Keung; Gao, Hong; Wong, Hee-Kit

doi:10.1016/s1474-4422(07)70079-0

Cited by 124 publications

(97 citation statements)

References 30 publications

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“…Angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers could have some benefit in term of improved survival at 1 year 3. β‐Blockers showed no effect on survival and recurrence rate,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 whereas calcium antagonists could be used if coronary vasospasm has been proven during coronary angiogram or with acetylcholine test 32…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Santoro

Stiermaier

Tarantino

et al. 2017

JAHA

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BackgroundLeft ventricular (LV) thrombi during Takotsubo syndrome represent a potential complication and can be associated with cerebrovascular embolic events. The aim of this study was to evaluate the exact incidence, predictors, and management strategies of LV thrombi in patients with Takotsubo syndrome.Methods and ResultsWe enrolled 541 consecutive patients in a multicenter international registry. Clinical features and echocardiographic data at admission, during hospitalization, and after 3 months were evaluated. Survival rates for long‐term follow‐up (mean 984±908 days) were recorded. Twelve Takotsubo syndrome patients (2.2%) developed LV thrombi (all female presenting with apical ballooning pattern). All patients with LV thrombi were treated with oral anticoagulation therapy; however, 2 (17%) had a stroke before treatment initiation. These patients were characterized by a higher prevalence of ST‐elevation (56% versus 16%; P<0.001) and higher troponin I levels (10.8±18.3 ng/mL versus 3.5±4.3 ng/mL; P=0.001) as compared with those without LV thrombi. At multivariate analysis including age, sex, LV ejection fraction, ST‐elevation at admission, and apical ballooning pattern, troponin I level >10 ng/mL was the only predictor for LV thrombosis (hazard ratio 6.6, confidence interval, 1.01–40.0; P=0.04). After 3 months all LV thrombi disappeared. Oral anticoagulation therapy was interrupted in all patients except 1. At long‐term follow‐up, the survival rate was not different between patients with and without LV thrombi (84% versus 85%; P=0.99).Conclusions LV thrombi have a relatively low incidence among patients with Takotsubo syndrome and were detected in female patients with apical ballooning pattern and increased troponin levels. Oral anticoagulation therapy for 3 months seems reasonable in these high‐risk patients.

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Section: Discussionmentioning

confidence: 99%

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Santoro

Stiermaier

Tarantino

et al. 2017

JAHA

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“…Early discontinuation of the RAPID (Rapid Anticoagulation Prevents Ischemic Damage) trial, after the enrollment of only 67 patients, precluded comparison of unfractionated heparin versus aspirin in the prevention of early recurrence 5 . A comparative analysis of the efficacy of low-molecular-weight heparin versus aspirin, conducted with Asian patients with intracranial stenosis and acute stroke, did not find heparin to be superior 6 . Recommendations 1) Routine anticoagulation with unfractionated or lowmolecular-weight heparin is not recommended in acute ischemic stroke (Level of Evidence 1, Class A Recommendation).…”

mentioning

confidence: 95%

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

Martins¹,

Freitas²,

Pontes-Neto³

et al. 2012

Arq. Neuro-Psiquiatr.

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“…Overall, no clear evidence favoring early anticoagulation was found supporting the use of heparin, heparinoids, LMWH or other agents after acute stroke for the secondary prevention of thromboembolic events, disabling sequelae or death. [12][13][14][15][16][17][18][19] Antiplatelet agents remain the first-choice of antithrombotic agents.…”

Section: Methodsmentioning

confidence: 99%

“…The results showed no significant benefit of nadroparin over aspirin in the patients assessed, and further investigation of anticoagulation in large-artery atherosclerosis patients was recommended. 18 The evidence of benefits from anticoagulation after acute stroke due to large-artery arteriosclerosis is also controversial. As previously outlined, in the TOAST trial a significant response to danaparoid treatment was observed at both 7 days and 3 months among individuals with ischemic stroke secondary to large-artery atherosclerosis.…”

Section: Methodsmentioning

confidence: 99%

Anticoagulation in acute ischemic stroke: A systematic search

Froio

Montgomery

David‐Neto

et al. 2017

Rev. Assoc. Med. Bras.

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Introduction: Stroke is one of the most important diseases worldwide. Several clinical scenarios demand full dose of anticoagulants primary to stroke etiology or to the treatment of comorbidity. However, controversy exists over many issues regarding anticoagulation treatment in stroke such as time for initiation, efficacy according to stroke etiology, the ideal dose of anticoagulants, and whether novel anticoagulants should be used. Method: Computerized search for clinical trials and randomized controlled clinical trials was done to the present date at Medline, Scielo, Embase, PsychInfo, and Cochrane Library using MeSH terms and the keywords stroke, ischemic stroke, anticoagulation, anticoagulants, heparin, low-molecular-weight heparin, warfarin, dabigatran, rivaroxaban, apixaban. The PRISMA statement was used to evaluate clinical trials. Results: Fourteen clinical trials were selected based on inclusion criteria. No evidence was found supporting the early use of heparin, heparinoids or low--molecular-weight heparin (LMWH) early after stroke. No consistent evidence for the use of warfarin and the newer oral anticoagulants were found. Argatroban was the only anticoagulant with significant positive results early after large-artery ischemic stroke. Conclusion:The ideal time for initiating anticoagulation remains undefined, requiring further investigation. Early anticoagulation for ischemic stroke is not recommended, with few exceptions, such as that of argatroban.

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Low-molecular-weight heparin compared with aspirin for the treatment of acute ischaemic stroke in Asian patients with large artery occlusive disease: a randomised study

Cited by 124 publications

References 30 publications

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

Anticoagulation in acute ischemic stroke: A systematic search

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