Low-Molecular-Weight Heparin or Dual Antiplatelet Therapy Is More Effective Than Aspirin Alone in Preventing Early Neurological Deterioration and Improving the 6-Month Outcome in Ischemic Stroke Patients

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Acute ischemic stroke (n=1467). Intervention: Dual antiplatelet therapy (DAT) or Low-molecular-weight heparin (LMWH) vs. Aspirin alone (200 mg daily). Primary outcome: Incidence of early neurological deterioration (END) within 10 days after admission (p=<0.001).

Xingyang Yi; Wanzhang Chi; Chun Wang; Biao Zhang; Jing Lin

doi:10.3988/jcn.2015.11.1.57

January 1, 2015Journal of Clinical NeurologyOpen Access

Low-Molecular-Weight Heparin or Dual Antiplatelet Therapy Is More Effective Than Aspirin Alone in Preventing Early Neurological Deterioration and Improving the 6-Month Outcome in Ischemic Stroke Patients

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Key result

Dual antiplatelet therapy and low-molecular-weight heparin significantly reduced early neurological deterioration compared to aspirin alone (4.12% and 3.11% vs 14.81%, p<0.001).

Why the study?

Does dual antiplatelet therapy or low-molecular-weight heparin reduce early neurological deterioration compared to aspirin alone in patients with acute ischemic stroke?

Study Design

Type

RCT (n=1,467)

Blinding

Open-label

Randomization

Computer-derived random sequences with sealed envelopes

Multicenter

Yes

Structured PICO

Does dual antiplatelet therapy or low-molecular-weight heparin reduce early neurological deterioration compared to aspirin alone in patients with acute ischemic stroke?

P

Population

1,467 patients aged 40-80 years with acute ischemic stroke admitted within 48 hours of symptom onset, randomized to aspirin, dual antiplatelet therapy, or low-molecular-weight heparin, and followed for 6 months.

I

Intervention

Dual antiplatelet therapy (aspirin 200 mg and clopidogrel 75 mg daily for 14 days, then aspirin 100 mg daily for 6 months) OR Low-molecular-weight heparin (enoxaparin 4,000 antifactor Xa IU subcutaneous twice daily for 14 days, then aspirin 100 mg daily for 6 months).

C

Comparator

Aspirin alone (200 mg daily for 14 days, followed by 100 mg daily for 6 months).

O

Outcome

Incidence of early neurological deterioration (END), defined as an increase in the NIHSS score of at least 4 points within 10 days after admission.hard clinical

Main Result

Absolute Event Rate: 4.12% vs 14.81%

p-value: p=<0.001

In patients with acute ischemic stroke, dual antiplatelet therapy or low-molecular-weight heparin significantly reduced the incidence of early neurological deterioration and early recurrent ischemic stroke compared to aspirin alone, without increasing bleeding risk.

Limitations

Nonblinded design
Two-center study with a relatively small sample size
Short duration of therapy exposure and outcome assessment

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Supports dual antiplatelet therapy or low-molecular-weight heparin over aspirin in acute ischemic stroke; confirms benefit in RCT for preventing early deterioration.

Abstract

Background and PurposezzDual antiplatelet therapy (DAT) with clopidogrel and aspirin has been shown to confer greater protection against early neurological deterioration (END) and early recurrent ischemic stroke (ERIS) than aspirin alone in patients who have experienced an acute ischemic stroke. However, few studies have compared the effects of anticoagulation therapy with low-molecular-weight heparin (LMWH), DAT, and aspirin.

Discussion

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Cite This Study

Yi et al. (2015) conducted an RCT in Acute ischemic stroke (n=1,467). Dual antiplatelet therapy (DAT) or Low-molecular-weight heparin (LMWH) vs. Aspirin alone (200 mg daily) was evaluated on Incidence of early neurological deterioration (END) within 10 days after admission (p=<0.001). Dual antiplatelet therapy and low-molecular-weight heparin significantly reduced early neurological deterioration compared to aspirin alone (4.12% and 3.11% vs 14.81%, p<0.001).

synapsesocial.com/papers/6a20836a7b2df09761f898b1 https://doi.org/10.3988/jcn.2015.11.1.57

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Low-Molecular-Weight Heparin or Dual Antiplatelet Therapy Is More Effective Than Aspirin Alone in Preventing Early Neurological Deterioration and Improving the 6-Month Outcome in Ischemic Stroke Patients

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Low-Molecular-Weight Heparin or Dual Antiplatelet Therapy Is More Effective Than Aspirin Alone in Preventing Early Neurological Deterioration and Improving the 6-Month Outcome in Ischemic Stroke Patients

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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