Usefulness of Heparin in Initial Management of Patients With Recent Transient Ischemic Attacks

Putman, S F; Adams, Harold P.

doi:10.1001/archneur.1985.04060090042011

Cited by 53 publications

(20 citation statements)

References 9 publications

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“…66 -74 Numerous studies also have shown that the short-term risk of stroke is particularly high, with most studies finding risks exceeding 10% in 90 days. 7,13,21,[75][76][77][78][79][80][81][82][83][84] Risk is particularly high in the first few days after TIA, with most studies finding that one quarter to one half of the strokes that occur within 3 months occur within the first 2 days. 7,21,75,79,82,84,85 For example, studies in northern California and Oxfordshire found the risk of stroke in the first 24 hours after TIA to be Ϸ4%, 75,86 which is about twice the risk of myocardial infarction or death in patients presenting with acute coronary syndromes (Ϸ2% at 24 hours).…”

Section: Tia: Short-term Stroke Riskmentioning

confidence: 99%

Definition and Evaluation of Transient Ischemic Attack

Easton

Saver²,

Albers³

et al. 2009

Stroke

1,557

563

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Abstract-Thishours of symptom onset, preferably with magnetic resonance imaging, including diffusion sequences; noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is reasonable; electrocardiography should occur as soon as possible after TIA and prolonged cardiac monitoring and echocardiography are reasonable in patients in whom the vascular etiology is not yet identified; routine blood tests are reasonable; and it is reasonable to hospitalize patients with TIA if they present within 72 hours and have an ABCD 2 score Ն3, indicating high risk of early recurrence, or the evaluation cannot be rapidly completed on an outpatient basis. Key Words: AHA Scientific Statements Ⅲ brain Ⅲ brain ischemia Ⅲ cerebral ischemia Ⅲ ischemia Ⅲ stroke Ⅲ transient ischemic attack Ⅲ acute stroke syndromes Ⅲ acute cerebrovascular syndromes R ecent scientific studies have revised our understanding of 3 key aspects of transient ischemic attack (TIA): how it is best defined, what the early risk of stroke and other vascular outcomes is, and how it is best evaluated. This statement reviews and synthesizes recent scientific advances regarding the definition, urgency, and evaluation of TIA and is designed to aid the clinician in the short-and long-term management of patients with TIA. DefinitionTIAs are brief episodes of neurological dysfunction resulting from focal cerebral ischemia not associated withThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on January 16, 2009. A copy of the statement is available at http://www.americanheart.org/presenter.jhtml?identifierϭ3003999 by selecting either the "topic list" link or the "chronological list" link (No. LS-2037). To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development, visit http://www.americanheart.org/presenter.jhtml?identifierϭ3023366.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml?identifierϭ4431. A link to the "Permission Request Form" appears on the right side of the page.© 2009 American Heart Association, Inc. UrgencyLarge cohort and population-based studies reported in the last 5 years have demonstrated a higher risk ...

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Section: Tia: Short-term Stroke Riskmentioning

confidence: 99%

Definition and Evaluation of Transient Ischemic Attack

Easton

Saver²,

Albers³

et al. 2009

Stroke

1,557

563

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“…In a nonrandomized study Putman and Adams 1 found that intravenous administration of heparin is associated with a 12.2% risk of hemorrhagic complications and that heparin failed to prevent recurrent TIAs or cerebral infarction among patients with recent (<72 hours) TIAs. Keith et al 2 reviewed the value of heparin therapy for recent (<30 days) TIAs and found no differences in the probabilities of death or survival free from TIAs or cerebral infarction for patients treated with heparin compared with a control group; they reported hemorrhagic complications at the rate of 3.2/100 person-days of heparin therapy.…”

Section: T He Administration Of Intravenous Heparin Inmentioning

confidence: 99%

A randomized trial of aspirin or heparin in hospitalized patients with recent transient ischemic attacks. A pilot study.

Biller

Bruno

Adams

et al. 1989

Stroke

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In a randomized pilot study we compared the efficacy of temporary anticoagulation with intravenous heparin sodium to the efficacy of aspirin in preventing cerebral infarction in hospitalized patients with recent (<7 days) transient ischemic attacks (TIAs). Fifty-five patients (33 men, 22 women) aged 36-81 (mean 62.7) years met entry criteria and agreed to participate. Symptoms prompting hospitalization were referable to the carotid distribution in 43 patients (34 hemispheric, nine retinal); 12 patients had vertebrobasilar distribution TIAs. Twenty-seven patients received heparin and 28 received aspirin. Patients were treated until surgery or until long-term medical therapy was instituted, 3-9 (mean 5.5) days in the heparin group and 3-15 (mean 5.8) days in the aspirin group. Recurrent TIAs occurred in eight patients given heparin and in seven treated with aspirin. Infarction occurred in one patient in the heparin group and in four patients in the aspirin group (three brain, one retinal infarction). Initial symptoms in these five patients were referable to the carotid distribution in two and to the vertebrobasilar distribution in three. All patients but the one with a retinal infarction had recurrent TIAs prior to stroke. Our pilot study suggests that hospitalized patients with recent TIAs are at high risk for recurrent TIAs (15 of 55, 27%) and brain infarction (five of 55, 9%) and that patients with recent vertebrobasilar distribution TIAs have a marginally significantly higher risk (odds ratio 6.83, 95% confidence interval 0.

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“…22 However, two of these five strokes were related to angiography, and another occurred when heparin was discontinued prior to carotid surgery. Hemorrhage occurred in nine patients (13%).…”

Section: -23mentioning

confidence: 99%