title: Low-molecular-weight heparin versus aspirin for acute ischemic stroke with large artery occlusive disease: subgroup analyses from the Fraxiparin in Stroke Study for the treatment of ischemic stroke (FISS-tris) study.
abstract: OBJECTIVE
  The Fraxiparin in Stroke Study for the treatment of ischemic stroke (FISS-tris) study showed no superiority of low-molecular-weight heparin (LMWH) over aspirin for the primary end point (Barthel Index) in acute ischemic stroke due to large artery occlusive disease. This study aims to evaluate the efficacy of LMWH and aspirin in selected subgroups so as to generate hypotheses for further studies.
  
  
  METHODS
  The FISS-tris study was a multicenter, randomized trial to investigate the efficacy and safety of LMWH (nadroparin calcium 3800 antifactor Xa IU/0.4 mL subcutaneously twice daily) or aspirin (160 mg once daily) for the treatment of patients with acute ischemic stroke and large artery occlusive disease. The primary outcome was the Barthel Index score dichotomized at 85 6 months poststroke. Exploratory subgroup analysis was performed using different levels of baseline characteristics and the distribution of symptomatic arteries.
  
  
  RESULTS
  Compared with aspirin, LMWH improved outcome among older patients >68 years (P=0.043; OR, 1.86; 95% CI, 1.02-3.41) without ongoing antiplatelet treatment on admission (P=0.029; OR, 1.85; 95% CI, 1.06-3.21) and with symptomatic posterior circulation arterial disease (P=0.001; OR, 5.76; 95% CI, 2.00-16.56).
  
  
  CONCLUSIONS
  Our findings suggest that LMWH may be of benefit in certain subgroups of patients with acute cerebral infarct and large artery occlusive disease. Hence, further investigation of LMWH may be justified in subgroups such as the elderly, nonusers of antiplatelet agents, and patients with posterior circulation stenosis.
  
  
  BACKGROUND
  URL: www.strokecenter.org/trials. Unique identifier: registration no. 493.
authors.affiliation: Department of Neurology, Shanghai First People's Hospital, Medical College, Shanghai Jiao Tong University, Shanghai, PR China.
authors.forename: Qiao Shu
authors.initials: QS
authors.lastname: Wang
authors.forename: Christopher
authors.initials: C
authors.lastname: Chen
authors.forename: Xiang Yan
authors.initials: XY
authors.lastname: Chen
authors.forename: Jing Hao
authors.initials: JH
authors.lastname: Han
authors.forename: Yannie
authors.initials: Y
authors.lastname: Soo
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Leung
authors.forename: Vincent
authors.initials: V
authors.lastname: Mok
authors.forename: Ka Sing Lawrence
authors.initials: KS
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001157:Arterial Occlusive Diseases / Q000188:drug therapy*; D001241:Aspirin / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006723:Hong Kong; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012846:Singapore; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D017762:Nadroparin; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin