Delayed occlusion after internal carotid artery dissection under heparin.
Internal carotid artery dissection (ICAD) is a frequent etiology of stroke in the young. Immediate anticoagulation with unfractionated heparin is the most frequent treatment. A theoretical side effect of unfractionated heparin is an increase in the intramural hematoma resulting in hemodynamic cerebral infarction. We studied 20 patients with ICAD. All patients were immediately treated with unfractionated heparin. Activated partial thromboplastin time (aPTT) ratios were measured twice daily. We prospectively monitored the course of ICAD with repeated ultrasound in hospital. Unexpectedly, delayed ICA occlusion was noted in 5 patients under treatment. One of these developed a watershed infarct. We then analyzed the aPTT ratios over the first 6 days after diagnosis. Patients with delayed occlusion had significantly higher aPTT ratios (2.6 +/- 0.4 vs. 2.0 +/- 0.5, p < 0.05). Within the limits of a partially retrospective design, our study seems to support the notion that unfractionated heparin can increase the intramural hematoma. Our findings further justify a randomized clinical trial to resolve the anticoagulant/antiplatelet debate.
Department of Neurology, Campus Mitte, Charité University of Medicine Berlin, Berlin, Germany. jens.dreier@charite.de
Jens P
JP
Dreier
Frank
F
Lurtzing
Melanie
M
Kappmeier
Georg
G
Bohner
Randolf
R
Klingebiel
Stefanie
S
Leistner
Karl M
KM
Einhaupl
Eva
E
Schielke
José M
JM
Valdueza
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D020215:Carotid Artery, Internal, Dissection / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000139:chemically induced* / Q000175:diagnosis; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D012189:Retrospective Studies; D013997:Time Factors
D000925:Anticoagulants; D006493:Heparin