title: Low-molecular-weight heparin is more effective than aspirin in preventing early neurologic deterioration and improving six-month outcome.
abstract: BACKGROUND
  We evaluated the efficacy of low-molecular-weight heparin (LMWH) relative to aspirin in preventing early neurologic deterioration (END), venous thromboembolism (VTE), and outcomes at 6 months.
  
  
  METHODS
  Patients were randomly assigned to receive either subcutaneous enoxaparin 4000 anti-factor Xa IU/0.4 mL twice daily or oral aspirin 200 mg daily for 10 days. After day 10, all subjects received aspirin 100 mg once daily for 6 months. We assessed whether LMWH was superior to aspirin in preventing END and VTE within the first 10 days after index stroke and evaluated 6-month outcomes.
  
  
  RESULTS
  Of the total 1368 patients, 7.89% suffered from END, and 2.85% suffered from deep-vein thrombosis during the first 10 days, with a significance difference between the LMWH group and aspirin group (3.95%, 1.46% versus 11.82%, 4.23%, respectively). At 6 months, there was a significant difference in the frequency of good outcomes among patients over the median age of 70 years (LMWH 63.8% versus aspirin 44.6%). The benefit of LMWH was also significant in patients with symptomatic stenosis of the posterior circulation and basilar artery (75.2% and 82% for LMWH versus 40.5% and 48% for aspirin, respectively).
  
  
  CONCLUSIONS
  For patients with acute ischemic stroke, treatment with LMWH within 48 hours of stroke until 10 days later may reduce END and deep-vein thrombosis during the first 10 days. LMWH appears to have advantages over aspirin in certain subgroups, such as elderly patients and patients with posterior circulation and basilar artery stenosis.
authors.affiliation: Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China.
authors.forename: Xingyang
authors.initials: X
authors.lastname: Yi
authors.affiliation: Department of Neurology, 3(rd) Affiliated Hospital of Wenzhou Medical College, Wenzhou 325200, Zhejiang, China. Electronic address: yixingyang64@126.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China.
authors.forename: Biao
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Neurology, 3(rd) Affiliated Hospital of Wenzhou Medical College, Wenzhou 325200, Zhejiang, China.
authors.forename: Wanzhang
authors.initials: W
authors.lastname: Chi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D001241:Aspirin
keywords: Acute ischemic stroke; anticoagulation; neurologic degeneration; outcomes; venous thromboembolism