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.

FINDINGS:

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: Xingyang Yi, Jing Lin, Chun Wang, Biao Zhang, Wanzhang Chi
• Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) Vol. 23 Issue 6 Pg. 1537-44 (Jul 2014) ISSN: 1532-8511 [Electronic] United States
• PMID: 24656240 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 National Stroke Association. All rights reserved.

Chemical References

• Anticoagulants
• Enoxaparin
• Aspirin

Topics

• Aged
• Aged, 80 and over
• Anticoagulants (therapeutic use)
• Aspirin (therapeutic use)
• Brain Ischemia (complications, drug therapy)
• Enoxaparin (therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• Nervous System Diseases (drug therapy, etiology, prevention & control)
• Stroke (complications, drug therapy)
• Treatment Outcome
• Venous Thromboembolism (drug therapy, etiology, prevention & control)