Review ArticlesLow molecular weight heparin versus aspirin for acute ischemic stroke: A systematic review*
Section snippets
Study identification
Studies were identified through searches of the Cochrane Library (Version 3, 2001), MEDLINE, and EMBASE using the search terms: ((heparin-low-molecular-weight or certoparin or dalteparin or enoxaparin or nadroparin or reviparin or tinzaparin) and aspirin) and (stroke or cerebr*). Searches of published systematic reviews3, 8, 9, 10, 11 and other reviews12, 13, 14, 15 of anticoagulant treatment in acute stroke, the reference lists of existing reports of LMWH in acute stroke, and a study of
Study identification and characteristics
Two completed trials were identified which fulfilled the inclusion criteria (Table 1).Both studies, Heparin in Acute Embolic Stroke Trial (HAEST)18, 19 and Tinzaparin in Acute Ischaemic Stroke Trial,17 had been published as full papers; data for TAIST were obtained from the final statistical analysis file (P Soerensen, Statistician, Leo Pharmaceuticals). Abstracted data from each trial were checked with the first authors of the trial papers. The 2 trials together studied 1,933 patients who were
Discussion
The routine use of LMWH in acute ischemic stroke by many stroke physicians can be questioned by the results of this systematic review. As compared with aspirin, LMWH did not improve functional outcome, a finding which mirrors an earlier systematic review comparing LMWH with placebo/control.9 This failure might simply reflect that LMWH are ineffective or that any beneficial effects are offset by hazard (for example, severe intracranial or extracranial bleeding).
A number of mechanisms have been
Acknowledgements
Philip Bath is Stroke Association Professor of Stroke Medicine; Fiona Bath was funded by the UK National Health Service Executive (Trent), grant No SPGS 236. The study was presented, in part, at the 10th European Stroke Conference, Lisbon, May 2001.27 The study received no funding from the pharmaceutical industry. We thank Eivind Berge (HAEST) and Ewa Lindenstrøm and Per Sørensen (Leo Pharmaceuticals, TAIST) for providing data for the analyses. Philip Bath was principal investigator and
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Low molecular weight heparins and heparinoids in acute ischaemic stroke: A systematic review
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2015, Stroke: Pathophysiology, Diagnosis, and ManagementTargeted use of heparin, heparinoids, or low-molecular-weight heparin to improve outcome after acute ischaemic stroke: An individual patient data meta-analysis of randomised controlled trials
2013, The Lancet NeurologyCitation Excerpt :Although heparins (unfractionated heparin, low-molecular-weight heparin, and heparinoids) can reduce the risk of recurrent ischaemic stroke, deep vein thrombosis, and pulmonary embolism, they also increase the risk of symptomatic intracranial and extracranial haemorrhage.5 In stroke, the benefits are exactly offset by the harms, and hence in systematic reviews of grouped data from randomised controlled trials of subcutaneous heparins, there was no net observable effect of anticoagulants on death or disability measured several months after stroke (even in selected subtypes).6–8 However, some clinicians still use heparin or low-molecular-weight heparin to prevent early recurrent stroke in patients who are felt to be at particularly high risk.9–13
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Address reprint requests to Philip Bath, FRCP, Division of Stroke Medicine, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UK.