title: A low-molecular-weight heparinoid compared with unfractionated heparin in the prevention of deep vein thrombosis in patients with acute ischemic stroke. A randomized, double-blind study.
abstract: OBJECTIVE
  To compare the relative safety and efficacy of a low-molecular-weight heparinoid (ORG 10172) with unfractionated heparin in the prevention of deep vein thrombosis in patients with acute ischemic stroke.
  
  
  METHODS
  Double-blind randomized trial.
  
  
  METHODS
  Seven Canadian university-affiliated hospitals.
  
  
  METHODS
  Eighty-seven patients with acute ischemic stroke resulting in lower-limb paresis.
  
  
  METHODS
  Patients received either low-molecular-weight heparinoid, 750 anti-factor Xa units twice daily, or unfractionated heparin, 5000 units subcutaneously twice daily. Treatment was continued for 14 days or until hospital discharge if sooner.
  
  
  METHODS
  Deep vein thrombosis was diagnosed using 125I-labeled fibrinogen leg scanning and impedance plethysmography. Venography was indicated if either test was positive. Overt hemorrhage, major or minor, was assessed clinically.
  
  
  RESULTS
  Venous thrombosis occurred in four patients (9%) given low-molecular-weight heparinoid and in 13 patients (31%) given heparin (relative risk reduction, 71%; 95% CI, 16% to 93%. The corresponding rates for proximal vein thrombosis were 4% and 12%, respectively (relative risk reduction, 63%; P greater than 0.2). The incidence of hemorrhage was 2% in both groups.
  
  
  CONCLUSIONS
  Low-molecular-weight heparinoid, given in a fixed dose of 750 anti-factor Xa units subcutaneously twice daily, is more effective than subcutaneous low-dose heparin for the prevention of deep vein thrombosis in patients with acute ischemic stroke.
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: A G
authors.initials: AG
authors.lastname: Turpie
authors.forename: M
authors.initials: M
authors.lastname: Gent
authors.forename: R
authors.initials: R
authors.lastname: Côte
authors.forename: M N
authors.initials: MN
authors.lastname: Levine
authors.forename: J S
authors.initials: JS
authors.lastname: Ginsberg
authors.forename: P J
authors.initials: PJ
authors.lastname: Powers
authors.forename: J
authors.initials: J
authors.lastname: Leclerc
authors.forename: W
authors.initials: W
authors.lastname: Geerts
authors.forename: R
authors.initials: R
authors.lastname: Jay
authors.forename: J
authors.initials: J
authors.lastname: Neemeh
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III / Q000187:drug effects; D002545:Brain Ischemia / Q000150:complications*; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004311:Double-Blind Method; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006025:Glycosaminoglycans / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006497:Heparan Sulfate; D006801:Humans; D008297:Male; D008875:Middle Aged; D013924:Thrombophlebitis / Q000150:complications / Q000517:prevention & control*
chemical_list: D000990:Antithrombin III; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D005343:Fibrinolytic Agents; D006025:Glycosaminoglycans; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid