title: Anticoagulants for acute ischaemic stroke.
abstract: BACKGROUND
  Most ischaemic strokes are caused by blood clots blocking an artery in the brain. Clot prevention with anticoagulant therapy could have a significant impact on patient survival, disability and recurrence of stroke.
  
  
  OBJECTIVE
  The objective of this review was to assess the effect of anticoagulant therapy in the early treatment of patients with acute ischaemic stroke.
  
  
  METHODS
  We searched the Cochrane Stroke Group trials register (most recent search: March 1999) and consulted MedStrategy (1995). We also contacted drug companies.
  
  
  METHODS
  Randomised trials comparing early anticoagulant therapy (started within two weeks of stroke onset) with control in patients with acute presumed or confirmed ischaemic stroke.
  
  
  METHODS
  Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data.
  
  
  RESULTS
  Twenty-one trials involving 23,427 patients were included. The quality of the trials varied considerably. The anticoagulants tested were standard unfractionated heparin, low-molecular-weight heparins, heparinoids, oral anticoagulants, and thrombin inhibitors. Based on eight trials (22,450 patients) there was no evidence that anticoagulant therapy reduced the odds of death from all causes (odds ratio 1.05, 95% confidence intervals 0.98-1.12). Similarly, based on five trials (21, 846 patients), there was no evidence that anticoagulants reduced the odds of being dead or dependent at the end of follow-up (odds ratio 0.99, 95% confidence intervals 0.94-1.05). Although anticoagulant therapy was associated with about 9 fewer recurrent ischaemic strokes per 1000 patients treated, it was also associated with a similar sized 9 per 1000 increase in symptomatic intracranial haemorrhages. Similarly, anticoagulants avoided about 4 pulmonary emboli per 1000, but this benefit was offset by an extra 9 major extracranial haemorrhages per 1000. Sensitivity analyses did not identify a particular type of anticoagulant regimen or patient characteristic associated with net benefit.
  
  
  CONCLUSIONS
  Immediate anticoagulant therapy in patients with acute ischaemic stroke is not associated with net short- or long-term benefit. The data from this review do not support the routine use of any type of anticoagulant in acute ischaemic stroke.
authors.affiliation: Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU. pags@skull.dcn.ed.ac.uk
authors.forename: G
authors.initials: G
authors.lastname: Gubitz
authors.forename: C
authors.initials: C
authors.lastname: Counsell
authors.forename: P
authors.initials: P
authors.lastname: Sandercock
authors.forename: D
authors.initials: D
authors.lastname: Signorini
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D012306:Risk; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants