Unfractionated heparin is associated with a lower rise of serum vascular cell adhesion molecule-1 in acute ischemic stroke patients.
We sought to assess the anti-inflammatory properties of unfractionated heparin (UFH) in patients with ischemic stroke treated within 24 h from the onset of symptoms. We studied prospectively 167 patients that received 1000 IU/h intravenous UFH (n=70) or 300 mg oral aspirin (n=97) at a mean treatment delay of 6.7 h. Repeated plasma levels of interleukin (IL)-6, IL-10, IL-4, tumor necrosis factor (TNF)-alpha, soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1) were compared in both groups using multivariate analyses. Whereas TNF-alpha and sICAM-1 decreased at 48 h, IL-6, IL-4, and sVCAM-1 increased compared with baseline values (P<0.01). The rise of sVCAM-1 levels at 48 h was significantly lower in patients treated with UFH (P=0.017) and a two-fold increase of baseline sVCAM-1 was an independent predictor of poor outcome (odds ratio, 2.19, 1.1-4.39). These results suggest that adjusted high-dose UFH has anti-inflammatory effects which might improve recovery if administered early after stroke onset.
Chamorro
Angel
A
Neurology Service, Hospital Clínic Universitari, 170 Villarroel, 08036, Barcelona, Spain. chamorro@medicina.ub.es
Cervera
Alvaro
A
Castillo
José
J
Dávalos
Antonio
A
Aponte
John J
JJ
Planas
Ana M
AM
D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000737:chemistry / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D002545:Brain Ischemia / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D005544:Forecasting; D006493:Heparin / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D016037:Single-Blind Method; D020521:Stroke / Q000097:blood* / Q000188:drug therapy*; D016896:Treatment Outcome; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D019010:Vascular Cell Adhesion Molecule-1; D006493:Heparin; D001241:Aspirin