Anticoagulation in acute ischaemic stroke: deep vein thrombosis prevention and long-term stroke outcomes.
Ischaemic stroke accounts for 70-85% of stroke incidence worldwide, causing substantial morbidity and mortality. Antiplatelet agents and carotid endarterectomy are effective in stroke prevention but active therapy for acute stroke is limited at present. Treatments investigated to date include thrombolysis and antiplatelet agents, both of which have been shown to modify the effects of stroke and provide a small long-term benefit in selected patients, and anticoagulation with heparin derivatives and oral agents. The value of unfractionated heparin (UFH) in modifying the acute effects of stroke has never been clearly established, and the risk of intracranial bleeding has limited its clinical application. However, disability and death following stroke stem from both the acute cerebral event and the secondary development of venous thromboembolism (VTE). Antithrombotic therapy may therefore, in principle, provide the dual benefit of retarding ongoing cerebral thrombosis and preventing secondary VTE. Low-molecular-weight heparins (LMWHs) and one heparinoid may have an improved ratio of antithrombotic action to haemorrhagic effect compared with UFH. Recent trials with these agents demonstrated a significant reduction in deep vein thrombosis and pulmonary embolism. Evidence has also emerged of improved long-term outcomes in terms of combined rates of death and residual disability, but data from different studies are conflicting. The potential role of LMWHs and heparinoids in acute stroke remains to be clarified.
Lensing
A W
AW
Centre for Vascular Medicine, University of Amsterdam, The Netherlands. a.w.lensing@amc.uva.nl
D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000628:therapy; D020521:Stroke / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control
D000925:Anticoagulants