Anticoagulant therapy for ischemic stroke: A review of literature

Mohammad Mehdi Shahpouri, Seyed Mousavi, Faribourz Khorvash, Seyed Morteza Mousavi, Tahereh Hoseini, Mohammad Mehdi Shahpouri, Seyed Mousavi, Faribourz Khorvash, Seyed Morteza Mousavi, Tahereh Hoseini

Abstract

For many years, anticoagulants have been used in the emergent treatment of patients with acute ischemic stroke. Anticoagulants are prescribed in an effort to prevent first or recurrent stroke, especially among patients with cardioembolism due to arterial fibrillation and large-artery atherosclerotic disease. Despite the widespread use, efficacy and safety of anticoagulants are controversial. Experts have given a broad spectrum of opinions. Surveys of practitioners have also demonstrated a lack of consensus on the use of anticoagulants for ischemic stroke. The uncertainty is due, in large part, to the lack of definitive clinical data. A review by the panel of the Stroke Council of the American Heart Association found no strong evidence for effectiveness of anticoagulants in treating acute ischemic stroke. Several clinical trials have suggested that utility of emergent anticoagulation has no significant effect in improving clinical outcomes for patients with acute ischemic stroke. In the present review, we have attempted to provide a framework for the emergent use of anticoagulants in acute ischemic stroke patients.

Keywords: Anticoagulants; Ischemic Stroke; Significant effect.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T, et al. Heart disease and stroke statistics--2006 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;113:e85–151.
    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Measuring the Global Burden of Disease and Risk Factors. Oxford University press and the world Bank. 2006
    1. Hosseini AA, Sobhani-Rad D, Ghandehari K, Benamer HT. Frequency and clinical patterns of stroke in Iran-Systematic and critical review. BMC Neurol. 2010;10:72.
    1. Harold P, Adams Emergency use of anticoagulation for treatment of patients with ischemic stroke. Stroke. 2002;33:856–61.
    1. Camerlingo M, Salvi P, Belloni G, Gamba T, Cesana BM, Mamoli A. Intravenous heparin started within the first 3 hours after onset of symptoms as a treatment for acute nonlacunar hemispheric cerebral infarctions. Stroke. 2005;36:2415–20.
    1. Cerebral embolism study group. Cardioembolic stroke, early anticoagulation, and brain hemorrhage. Arch Intern Med. 1987;147:636–40.
    1. Cerebral embolism study group. Immediate anticoagulation of embolic stroke: Brain hemorrhage and management options. Stroke. 1989;15:779–89.
    1. Berge E, Abdelnoor M, Nakstad PH, Sandset PM. Low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation: A double-blind randomised study. HAEST Study Group. Heparin in Acute Embolic Stroke Trial. Lancet. 2000;355:1205–10.
    1. The Publications Committee for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Low molecular weight heparinoid, ORG 10172 (danaparoid), and outcome after acute ischemic stroke: A randomized controlled trial. JAMA. 1998;279:1265–72.
    1. International Stroke Trial Collaborative Group. The International Stroke Trial (IST): A randomized trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet. 1997;349:1569–81.
    1. CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: Randomized placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet. 1997;349:1641–9.
    1. Qureshi AI. Endovascular treatment of cerebrovascular diseases and intracranial neoplasms. Lancet. 2004;363:804–13.
    1. Hickey JV. The clinical practice of neurological and neurosurgical nursing. 6th ed. Philadelphia: Lippincott, Williams and Wilkins; 2008.
    1. Cea W, Dennis M, van Gign J, Hankey GJ, Sandercock P, Bamford J. Stroke: A practical guide to management. 2nd ed. London: Blackwell Science; 2001.
    1. Neuroscience Nursing; American Association of Neuroscience Nurses. American Association of Neuroscience Nursing core curriculum for neuroscience nursing. (5th edition) 2010
    1. Blank-Reid C. How to have a stroke at an early age: The effects of crack, cocaine and other illicit drugs. J Neurosci Nurs. 1996;28:19–27.
    1. Hinkle JL, Bowman L. Neuroprotection for ischemic stroke. J Neurosci Nurs. 2003;35:114–8.
    1. Muir KW, Buchan A, von KR, Rother J, Baron JC. Imaging of acute stroke. Lancet Neurol. 2006;5:755–68.
    1. Adams HP, Jr, Bendixen BH, Leira E, Chang KC, Davis PH, Woolson RF, et al. Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) Neurology. 1999;53:122–5.
    1. Wong KS, Chen C, Ng PW, Tsoi TH, Li HL, Fong WC, et al. Low-molecular-weight heparin compared with aspirin for the treatment of acute ischaemic stroke in Asian patients with large artery occlusive disease: A randomised study. Lancet Neurol. 2007;6:407–13.
    1. Kay R, Wong KS, Yu YL, Chan YW, Tsoi TH, Ahuja AT, et al. Low-molecular-weight heparin for the treatment of acute ischemic stroke. N Engl J Med. 1995;333:1588–93.
    1. Diener HC, Ringelstein EB, von Kummer R, Langohr HD, Bewermeyer H, Landgraf H, et al. Treatment of acute ischemic stroke with the low-molecular-weight heparin certoparin: Results of the TOPAS trial. Therapy of Patients With Acute Stroke (TOPAS) Investigators. Stroke. 2001;32:22–9.
    1. Baker RN. Anticoagulant therapy in cerebral infarction.Report on cooperative study. Neurology. 1962;12:823–35.
    1. Paciaroni M, Agnelli G, Micheli S, Caso V. Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: A meta-analysis of randomized controlled trials. Stroke. 2007;38:423–30.
    1. Thatai D, Ahooja V, Pullicino PM. Pharmacological prevention of thromboembolism in patients with left ventricular dysfunction. Am J Cardiovasc Drugs. 2006;6:41–9.
    1. Pullicino P, Thompson JL, Barton B, Levin B, Graham S, Freudenberger RS. Warfarin versus aspirin in patients with reduced cardiac ejection fraction (WARCEF): Rationale, objectives, and design. J Card Fail. 2006;12:39–46.
    1. Fisher CM. The use of anticoagulants in cerebral thrombosis. Neurology. 1958;8:311–32.
    1. Fisher CM. Anticoagulant therapy in cerebral thrombosis and cerebral embolism.A national cooperative study, interim report. Neurology. 1961;11:119–31.
    1. Haley EC, Jr, Kassell NF, Torner JC. Failure of heparin to prevent progression in progressing ischemic infarction. Stroke. 1988;19:10–4.
    1. Roden-Jullig A, Britton M. Effectiveness of heparin treatment for progressing ischaemic stroke: Before and after study. J Intern Med. 2000;248:287–91.
    1. Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P. Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest. 2008;133(6 Suppl):630S–9S.
    1. Menon R, Kerry S, Norris JW, Markus HS. Treatment of cervical artery dissection: A systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2008;79:1122–7.
    1. Bousser MG, Ferro JM. Cerebral venous thrombosis: An update. Lancet Neurol. 2007;6:162–70.
    1. Saadatnia M, Mousavi SA, Haghighi S, Aminorroaya A. Cerebral vein and sinus thrombosis in Isfahan-Iran: A changing profile. Can J Neurol Sci. 2004;31:474–7.
    1. Girot M, Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F, et al. Predictors of outcome in patients with cerebral venous thrombosis and intracerebral hemorrhage. Stroke. 2007;38:337–42.
    1. Einhaupl KM, Villringer A, Meister W, Mehraein S, Garner C, Pellkofer M, et al. Heparin treatment in sinus venous thrombosis. Lancet. 1991;338:597–600.
    1. De Bruijn SF, Stam J. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke. 1999;30:484–8.
    1. Stam J, De Bruijn SF, DeVeber G. Anticoagulation for cerebral sinus thrombosis. Cochrane Database Syst Rev. 2002;(4):CD002005.
    1. Nagaraja D, Rao BSS, Taly AB. Randomized controlled trial of heparin in therapy of cerebral venous/sinus thrombosis. Neurology India Nimhans J. 1995;13:111–5.
    1. Preter M, Tzourio C, Ameri A, Bousser MG. Long-term prognosis in cerebral venous thrombosis.Follow-up of 77 patients. Stroke. 1996;27:243–6.
    1. Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis: Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) Stroke. 2004;35:664–70.
    1. Ferro JM, Correia M, Pontes C, Baptista MV, Pita F. Cerebral vein and dural sinus thrombosis in Portugal: 1980-1998. Cerebrovasc Dis. 2001;11:177–82.
    1. Brucker AB, Vollert-Rogenhofer H, Wagner M, Stieglbauer K, Felber S, Trenkler J, et al. Heparin treatment in acute cerebral sinus venous thrombosis: A retrospective clinical and MR analysis of 42 cases. Cerebrovasc Dis. 1998;8:331–7.
    1. Ameri A, Bousser MG. Cerebral venous thrombosis. Neurol Clin. 1992;10:87–111.
    1. Woessner R, Grauer M, Bianchi O, Mueller M, Moersdorf S, Berlit P, et al. Treatment with anticoagulants in cerebral events (TRACE) Thromb Haemost. 2004;91:690–3.
    1. Hillbom M, Erilä T, Sotaniemi K, Tatlisumak T, Sarna S, Kaste M. Enoxaparin vs heparin for prevention of deep-vein thrombosis in acute ischaemic stroke: A randomized, double-blind study. Acta Neurol Scand. 2002;106:84–92.
    1. Sandercock PA, Counsell C, Gubitz GJ, Tseng MC. Antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev. 2008;(3):CD000029.
    1. Berge E, Sandercock P. Anticoagulants versus antiplatelet agents for acute ischaemic stroke. Cochrane Database Syst Rev. 2002;(4):CD003242.
    1. von KR, Gahn G. Comparison of diffusion-weighted MRI and CT in acute stroke. Neurology. 2000;55:1760.
    1. Thijs VN, Lansberg MG, Beaulieu C, Marks MP, Moseley ME, Albers GW. Is early ischemic lesion volume on diffusion-weighted imaging an independent predictor of stroke outcome. A multivariable analysis? Stroke. 2000;31:2597–602.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅