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Previous Volume 333:1588-1594 December 14, 1995 Number 24 Next

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ABSTRACT

Background Despite doubts about their efficacy and concern about their safety, antithrombotic agents are often used to treat acute ischemic stroke. Recent experience in patients with other thromboembolic disorders suggests that low-molecular-weight heparin, which requires only subcutaneous administration once or twice daily, may be more effective and safer than standard (unfractionated) heparin.

Methods We conducted a randomized, double-blind, placebo-controlled trial comparing two dosages of low-molecular-weight heparin with placebo in the treatment of ischemic stroke. Patients were randomly assigned within 48 hours of the onset of symptoms to receive high-dose nadroparin (4100 anti–factor Xa IU twice daily), low-dose nadroparin (4100 IU once daily), or placebo subcutaneously for 10 days. The primary measure of outcome was death or dependency regarding activities of daily living six months after randomization. Secondary outcomes were death, hemorrhagic transformation of the infarction, and other complications at 10 days, and death or dependency at 3 months.

Results A total of 2750 patients were screened for the study. Among 312 patients randomized, 306 had outcomes that were analyzed at six months. Forty-five patients (45 percent) in the high-dose group, 53 patients (52 percent) in the low-dose group, and 68 patients (65 percent) in the placebo group died or became dependent. There was a significant dose-dependent effect among the three study groups in favor of low-molecular-weight heparin (P = 0.005 by the chi-square test for trend). No significant differences among the groups in the occurrence of secondary outcomes were observed at 10 days.

Conclusions For patients with ischemic stroke treated within 48 hours of the onset of symptoms, low-molecular-weight heparin was effective in improving outcomes at six months.

Source Information

From the Departments of Medicine (R.K., K.S.W., A.W., J.W.) and Diagnostic Radiology and Organ Imaging (A.T.A.), Prince of Wales Hospital; the Departments of Medicine (Y.L.Y., K.Y.F.) and Diagnostic Radiology (F.L.C.), Queen Mary Hospital; the Department of Medicine and Geriatrics, Kwong Wah Hospital (Y.W.C., C.B.L.); and the Department of Medicine, Pamela Youde Nethersole Eastern Hospital (T.H.T.) — all in Hong Kong.

Address reprint requests to Dr. Kay at the Department of Medicine, Prince of Wales Hospital, Shatin, Hong Kong.

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Low-Molecular-Weight Heparin for the Treatment of Acute Ischemic Stroke
Bloom J. M., Kay R., Wong K. S., Woo J.
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N Engl J Med 1996; 334:1407, May 23, 1996. Correspondence

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• Brott, T., Bogousslavsky, J. (2000). Treatment of Acute Ischemic Stroke. NEJM 343: 710-722 [Full Text]  
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• DEVUYST, G, BOGOUSSLAVSKY, J (1999). Recent progress in drug treatment for acute stroke. J. Neurol. Neurosurg. Psychiatry 67: 420-425 [Full Text]  
• Anderson, J. W, Smith, B. M, Washnock, C. S (1999). Cardiovascular and renal benefits of dry bean and soybean intake. Am. J. Clin. Nutr. 70: 464S-474 [Abstract] [Full Text]  
• Grau, A. J., Hacke, W. (1999). Is There Still a Role for Intravenous Heparin in Acute Stroke?: Yes. Arch Neurol 56: 1159-1160 [Full Text]  
• Sandercock, P. (1999). Is There Still a Role for Intravenous Heparin in Acute Stroke?: No. Arch Neurol 56: 1160-1162 [Full Text]  
• Davis, M., Barer, D. (1999). Neuroprotection in acute ischaemic stroke. II: Clinical potential. Vasc Med 4: 149-163 [Abstract]  
• Sulter, G., Steen, C., Jacques De Keyser, (1999). Use of the Barthel Index and Modified Rankin Scale in Acute Stroke Trials. Stroke 30: 1538-1541 [Abstract] [Full Text]  
• Adams, H. P. Jr., Bendixen, B. H., Leira, E., Chang, K. C., Davis, P. H., Woolson, R. F., Clarke, W. R., Hansen, M. D. (1999). 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 53: 122-122 [Abstract] [Full Text]  
• Jaillard, A., Cornu, C., Durieux, A., Moulin, T., Boutitie, F., Lees, K. R., Hommel, M. (1999). Hemorrhagic Transformation in Acute Ischemic Stroke : The MAST-E Study. Stroke 30: 1326-1332 [Abstract] [Full Text]  
• Kirkham, F J (1999). Stroke in childhood. Arch. Dis. Child. 81: 85-89 [Full Text]  
• Barnett, H. J M, Eliasziw, M., Meldrum, H. E (1999). Evidence based cardiology: Prevention of ischaemic stroke. BMJ 318: 1539-1543 [Full Text]  
• Baughman, R. A., Kapoor, S. C., Agarwal, R. K., Kisicki, J., Catella-Lawson, F., FitzGerald, G. A. (1998). Oral Delivery of Anticoagulant Doses of Heparin : A Randomized, Double-Blind, Controlled Study in Humans. Circulation 98: 1610-1615 [Abstract] [Full Text]  
• Moroney, J. T., Bagiella, E., Paik, M. C., Sacco, R. L., Desmond, D. W. (1998). Risk Factors for Early Recurrence After Ischemic Stroke : The Role of Stroke Syndrome and Subtype. Stroke 29: 2118-2124 [Abstract] [Full Text]  
• McCarron, M. O., Muir, K. W., Weir, C. J., Dyker, A. G., Bone, I., Nicoll, J.A.R., Lees, K.R. (1998). The Apolipoprotein E {epsilon}4 Allele and Outcome in Cerebrovascular Disease. Stroke 29: 1882-1887 [Abstract] [Full Text]  
• The Publications Committee for the Trial of ORG 10, (1998). Low Molecular Weight Heparinoid, ORG 10172 (Danaparoid), and Outcome After Acute Ischemic Stroke: A Randomized Controlled Trial. JAMA 279: 1265-1272 [Abstract] [Full Text]  
• Bounameaux, H. (1998). Unfractionated versus low-molecular-weight heparin in the treatment of venous thromboembolism. Vasc Med 3: 41-46 [Abstract]  
• Grotta, J. C., Alexandrov, A. V. (1998). tPA-Associated Reperfusion After Acute Stroke Demonstrated by SPECT. Stroke 29: 429-432 [Abstract] [Full Text]  
• De Deyn, P. P., De Reuck, J., Deberdt, W., Vlietinck, R., Orgogozo, J.-M. (1997). Treatment of Acute Ischemic Stroke With Piracetam. Stroke 28: 2347-2352 [Abstract] [Full Text]  
• Brass, L. M., Krumholz, H. M., Scinto, J. M., Radford, M. (1997). Warfarin Use Among Patients With Atrial Fibrillation. Stroke 28: 2382-2389 [Abstract] [Full Text]  
• Hull, R. D., Raskob, G. E., Brant, R. F., Pineo, G. F., Valentine, K. A. (1997). The Importance of Initial Heparin Treatment on Long-term Clinical Outcomes of Antithrombotic Therapy: The Emerging Theme of Delayed Recurrence. Arch Intern Med 157: 2317-2321 [Abstract]  
• Weitz, J. I. (1997). Low-Molecular-Weight Heparins. NEJM 337: 688-699 [Full Text]  
• Alexandrov, A. V., Masdeu, J. C., Devous, M. D. Sr, Black, S. E., Grotta, J. C. (1997). Brain Single-Photon Emission CT With HMPAO and Safety of Thrombolytic Therapy in Acute Ischemic Stroke : Proceedings of the Meeting of the SPECT Safe Thrombolysis Study Collaborators and the Members of the Brain Imaging Council of the Society of Nuclear Medicine. Stroke 28: 1830-1834 [Abstract] [Full Text]  
• Cohen, M., Demers, C., Gurfinkel, E. P., Turpie, A. G.G., Fromell, G. J., Goodman, S., Langer, A., Califf, R. M., Fox, K. A.A., Premmereur, J., Bigonzi, F., Stephens, J., Weatherley, B., The Efficacy and Safety of Subcutaneous Enoxaparin, (1997). A Comparison of Low-Molecular-Weight Heparin with Unfractionated Heparin for Unstable Coronary Artery Disease. NEJM 337: 447-452 [Abstract] [Full Text]  
• Helgason, C. M., Wolf, P. A. (1997). American Heart Association Prevention Conference IV: Prevention and Rehabilitation of Stroke : Introduction. Stroke 28: 1498-1500 [Full Text]  
• Klein, W., Buchwald, A., Hillis, S. E., Monrad, S., Sanz, G., Turpie, A. G. G., van der Meer, J., Olaisson, E., Undeland, S., Ludwig, K. (1997). Comparison of Low-Molecular-Weight Heparin With Unfractionated Heparin Acutely and With Placebo for 6 Weeks in the Management of Unstable Coronary Artery Disease : Fragmin in Unstable Coronary Artery Disease Study (FRIC). Circulation 96: 61-68 [Abstract] [Full Text]  
• Alexandrov, A. V., Black, S. E., Ehrlich, L. E., Caldwell, C. B., Norris, J. W. (1997). Predictors of Hemorrhagic Transformation Occurring Spontaneously and on Anticoagulants in Patients With Acute Ischemic Stroke. Stroke 28: 1198-1202 [Abstract] [Full Text]  
• Grotta, J. (1996). Rodent Models of Stroke Limitations: What Can We Learn From Recent Clinical Trials of Thrombolysis?. Arch Neurol 53: 1067-1070 [Abstract]  
• Dorman, P. J., Sandercock, P. A.G. (1996). Considerations in the Design of Clinical Trials of Neuroprotective Therapy in Acute Stroke. Stroke 27: 1507-1515 [Full Text]  
• Faden, A. I. (1996). Pharmacologic Treatment of Acute Traumatic Brain Injury. JAMA 276: 569-570 [Abstract]  
• Bloom, J. M., Kay, R., Wong, K. S., Woo, J. (1996). Low-Molecular-Weight Heparin for the Treatment of Acute Ischemic Stroke. NEJM 334: 1407-1407 [Full Text]  
• Ferguson, J. J. (1996). New Treatments for Acute Ischemic Stroke. Circulation 93: 1604-1604 [Full Text]  
• van Gijn, J. (1996). Thrombolysis in Ischemic Stroke: Double or Quits?. Circulation 93: 1616-1617 [Full Text]  
• Alexandrov, A. V., Pullicino, P. M., Meslin, E. M., Norris, J. W. (1996). Agreement on Disease-Specific Criteria for Do-Not-Resuscitate Orders in Acute Stroke. Stroke 27: 232-237 [Abstract] [Full Text]  
• (1996). ANTITHROMBOTIC THERAPIES FOR ACUTE ISCHEMIC STROKE. JWatch General 1996: 2-2 [Full Text]