title: Effectiveness of heparin treatment for progressing ischaemic stroke: before and after study.
abstract: OBJECTIVE
  During the acute phase of stroke, symptoms progress in 25% of patients, resulting in a worse outcome. Could heparin treatment improve the situation?
  
  
  METHODS
  Before and after study. During the first period, no treatment was given to patients with progress of symptoms, whereas heparin was used regularly in the second period. A comparison of outcome was performed.
  
  
  METHODS
  Patients with acute stroke cared for in stroke units of two big emergency hospitals in Stockholm. Besides heparin treatment, the groups were taken care of according to the same basic principles.
  
  
  METHODS
  Consecutive patients admitted to a stroke unit during two periods of time. The first study comprised 314 patients with ischaemic stroke and the second 907.
  
  
  METHODS
  In the treatment period, patients with ischaemic stroke and objectively recognized progression received heparin infusion for at least 5 days.
  
  
  METHODS
  Continued progression, length of stay, unaided walking at discharge, discharge destination and mortality.
  
  
  RESULTS
  The progression rate was non-significantly higher in the first period: 28 vs. 21%. One-third continued to progress regardless of treatment given. Patients with progression, treated and untreated alike, had 40% longer stay in the stroke unit compared with stable patients, whereas mortality was unaffected. Treatment did not reduce the proportion of patients who needed aid for walking at discharge (77 vs. 74%) or those who needed further institutionalized care (65 vs. 66%).
  
  
  CONCLUSIONS
  Progression of focal stroke symptoms still constitutes a serious clinical problem for which heparin has insufficient effectiveness in clinical practice. New therapies, ideally preventive, are needed.
authors.affiliation: Karolinska Institutet, Division of Internal Medicine, Danderyd Hospital, Sweden. asa.jullig@tietoenator.com
authors.forename: A
authors.initials: A
authors.lastname: Rödén-Jüllig
authors.forename: M
authors.initials: M
authors.lastname: Britton
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
chemical_list: D000925:Anticoagulants; D006493:Heparin