Low-Molecular-Weight Heparin or Dual Antiplatelet Therapy Is More Effective Than Aspirin Alone in Preventing Early Neurological Deterioration and Improving the 6-Month Outcome in Ischemic Stroke Patients

Abstract

Background and PurposeDual antiplatelet therapy (DAT) with clopidogrel and aspirin has been shown to confer greater protection against early neurological deterioration (END) and early recurrent ischemic stroke (ERIS) than aspirin alone in patients who have experienced an acute ischemic stroke. However, few studies have compared the effects of anticoagulation therapy with low-molecular-weight heparin (LMWH), DAT, and aspirin.MethodsPatients with acute ischemic stroke (n=1,467) were randomized to therapy groups receiving aspirin (200 mg daily for 14 days, followed by 100 mg daily for 6 months), DAT (200 mg of aspirin and 75 mg of clopidogrel daily for 14 days, then 100 mg of aspirin daily for 6 months), or LMWH (4,000 antifactor Xa IU of enoxaparin in 0.4 mL subcutaneously twice daily for 14 days, followed by 100 mg of aspirin daily for 6 months). The effects of these treatment strategies on the incidence of END, ERIS, and deep-vein thrombosis (DVT) were observed for 10-14 days after treatment, and their impacts on a good outcome were evaluated at 6 months.ResultsThe DAT and LMWH were associated with a more significant reduction of END and ERIS within 14 days compared with aspirin-alone therapy. In addition, LMWH was associated with a significantly lower incidence of DVT within 14 days. At 6 months, DAT or LMWH improved the outcome among patients aged >70 years and those with symptomatic stenosis in the posterior circulation or basilar artery compared with aspirin.ConclusionsLMWH or DAT may be more effective than aspirin alone for reducing the incidence of END and ERIS within 14 days, and is associated with improved outcomes in elderly patients and those with stenosis in the posterior circulation or basilar artery at 6 months poststroke.

Hypercoagulation on Thromboelastography Predicts Early Neurological Deterioration in Patients with Acute Ischemic Stroke

“…A recent study on mild or moderate stroke (NIHSS ≤14) showed that early anticoagulation with low-molecularweight heparin (LMWH) could reduce the risk of END by approximately 80% compared with aspirin alone [16]. The mechanism of this advantage remains unclear.…”

Platelet Activation and Clopidogrel Effects on ADP‐Induced Platelet Activation in Cats with or without the A31P Mutation in MYBPC3

“…3,14 In human patients, clopidogrel is a key component of antithrombotic treatment in patients with acute ischemic stroke and coronary stent implantation. [15][16][17] However, substantial interindividual variability exists and resistance to clopidogrel is Abbreviations:…”

Interaction among COX-2, P2Y1 and GPIIIa gene variants is associated with aspirin resistance and early neurological deterioration in Chinese stroke patients

“…While the mechanisms underpinning END have not been fully understood. Thrombosis is one of the causes of ischemic stroke, and platelet activation plays a key role in thrombosis [40], IS and END pathogenesis [26, 41]. AR and high-risk interactive genotypes may reduce inhibition of platelet activation [7], leading to END.…”

“…The primary outcome was END, defined as an increase in NIHSS score of ≥ 4 points within 10 days of admission, after exclusion of hemorrhagic transformation of infarct or a new infarct in another vascular territory as previously described [26]. The secondary outcome was a composite of ERIS, myocardial infarction (MI), and death within 10 days of admission.…”

“…The secondary outcome was a composite of ERIS, myocardial infarction (MI), and death within 10 days of admission. ERIS was defined as a sudden and new focal neurologic deficit of vascular origin lasting at least 24 h, indicated in a diffusion-weighted image [26]. Death was defined as all-cause mortality.…”