Emergent use of anticoagulation for treatment of patients with ischemic stroke.
BACKGROUND
Several clinical trials have tested the potential utility of emergent anticoagulation for acute ischemic stroke.


RESULTS
Rather than performing a meta-analysis that combines the data from several trials, this review focuses on individual studies. Although these trials do have inherent limitations, they demonstrate that emergent use of an anticoagulant is associated with a modest but significantly increased risk of hemorrhagic transformation of the ischemic stroke or serious nonneurological bleeding. The trials do not demonstrate a benefit from emergent anticoagulation in improving outcome, reducing mortality, and preventing early recurrent stroke.


CONCLUSIONS
These results suggest that most patients with acute stroke should not be treated with unfractionated heparin or other rapidly acting anticoagulants after stroke. Prevention of deep vein thrombosis and pulmonary embolism among bedridden patients is the only established indication for early anticoagulation after acute ischemic stroke.
Adams
Harold P
HP
Department of Neurology, University of Iowa College of Medicine, Iowa City 52242, USA. harold-adams@uiuowa.edu
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D018450:Disease Progression; D004638:Emergency Treatment / Q000009:adverse effects; D006801:Humans; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
D000925:Anticoagulants