Stroke, ischemic: heparins for acute treatment
DISEASE INTERVENTION COMPARISON RESULTS
Cochrane Database Syst Rev. 2004;(3):CD000024 Systematic Review, Cochrane Review
IN stroke, ischemic, cerebral infarction The Use of
unfractionated heparin (UFH), low-molecular-weight heparins (LMWH)
As Treatment, Acute
Is equal Than
antiplatelet drugs, aspirin
To reduce recurrent stroke: anticoagulants were associated with 9/1000 fewer recurrent ischaemic strokes (OR 0.76, 0.65 to 0.88), but were also associated with a similar 9/1000 increase in symptomatic intracranial haemorrhages (OR 2.52, 1.92 to 3.30)
Lancet. 2000 Apr 8;355(9211):1205-10 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, embolic The Use of
heparin, low molecular weight, dalteparin full-dose (100 IU/Kg/12h)
As Treatment, Acute
Is equal Than
aspirin
To reduce recurrent ischaemic stroke (8.5% LMWH vs 7.5% aspirin), cerebral haemorrhage or death during the first 14 days. Death and functional outcome at 3 months were also equals,
Stroke. 2007 Feb;38(2):423-30 Meta-Analysis
IN stroke, ischemic, cerebral infarction, embolic The Use of
unfractionated heparin, low-molecular-weight heparins (LMWH), or heparinoids
As Treatment, Acute
Is equal Than
aspirin or placebo
To reduce death or disability at final follow up (73.5% heparin VS 73.8% aspirin). Heparins non-significantly reduced early recurrent ischemic stroke but significantly increased symptomatic intracranial bleeding .
Lancet. 1997 May 31;349(9065):1569-1581 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, thrombotic The Use of
antiplatelet drugs, aspirin 300 mg/d
As Treatment, Acute
Is better Than
placebo or unfractionated heparin (UFH), either low or full-dose
To reduce at 14 days recurrent ischaemic strokes (2.8% aspirin VS 3.9% placebo) or death plus non-fatal recurrent stroke (11.3% aspirin vs 12.4% placebo)
Ann Intern Med. 1986 Dec;105(6):825-828 Randomized Controlled Trial
IN stroke, ischemic, cerebral infarction, thrombotic The Use of
heparin, unfractionated, continuous intravenous heparin
As Treatment, Acute
Is equal Than
placebo
To modify the incidence of stroke progression, final functional status or mortality (more long-term mortality in patients who had received heparin)
N Engl J Med. 1995 Dec 14;333(24):1588-1593 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, thrombotic The Use of
low molecular weight heparins (LMWH), nadroparin (4100 anti-factor Xa IU twice daily for 10 days)
As Treatment, Acute
Is better Than
placebo
To reduce death or dependance at 6 months: 45% high-dose nadroparin VS 52% low-dose nadroparin VS 65% with placebo