title: Study of the Efficacy, Safety and Tolerability of Low-Molecular-Weight Heparin vs. Unfractionated Heparin as Bridging Therapy in Patients with Embolic Stroke due to Atrial Fibrillation.
abstract: BACKGROUND
  Anticoagulation with adjusted dose warfarin is a well-accepted treatment for the prevention of recurrent stroke in patients with atrial fibrillation. Meanwhile, using bridging therapy with heparin or heparinoids before warfarin for initiation of anticoagulation is a matter of debate. We compared safety, efficacy, and tolerability of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) as a bridging method in patients with recent ischemic stroke due to atrial fibrillation.
  
  
  METHODS
  This study was a randomized single-blind controlled trial in patients with acute ischemic stroke due to atrial fibrillation who were eligible for receiving warfarin and were randomly treated with 60 milligrams (mg) of LMWH (enoxaparin) subcutaneously every 12 h, or 1000 units/h of continuous intravenous heparin. The primary efficacy endpoints were recurrence of new ischemic stroke, myocardial infarction and/or death. The primary safety endpoint was central nervous system and/or systemic bleeding.
  
  
  RESULTS
  Seventy-four subjects were recruited. Baseline demographic and clinical characteristics of two groups were matched. Composite endpoint outcome of new ischemic stroke, myocardial infarction, and/or death in follow-up period was seen in 10 subjects (27.03%) in UFH group and in four subjects (10.81%) in LMWH group (p value: 0.136). All hemorrhages and symptomatic central nervous system (CNS) hemorrhages in follow-up period were in 7 (18.9%) and 4 (10.8%) patients in UFH group, in 5 (13.5%), and 3 (8.1%) patients in LMWH group (p values: 0.754 and 0.751), respectively. Drop out and major adverse-effects such as heparin-induced thrombocytopenia and drug hypersensitivity were not seen in any patient.
  
  
  CONCLUSIONS
  Enoxaparin can be a safe and efficient alternative for UFH as bridging therapy.
authors.affiliation: Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; These authors contributed equally to this work.
authors.forename: Farnia
authors.initials: F
authors.lastname: Feiz
authors.affiliation: Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; These authors contributed equally to this work.
authors.forename: Reyhane
authors.initials: R
authors.lastname: Sedghi
authors.affiliation: Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Salehi
authors.affiliation: School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Hatam
authors.affiliation: School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Jamshid
authors.initials: J
authors.lastname: Bahmei
authors.affiliation: Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Afshin
authors.initials: A
authors.lastname: Borhani-Haghighi
keywords: Atrial fibrillation; embolic; low-molecular-weight heparin; stroke; unfractionated heparin