Key result
Emergent anticoagulation for acute ischemic stroke does not improve outcomes or reduce mortality, but significantly increases the risk of hemorrhagic transformation and serious bleeding.
Why the study?
Does emergent anticoagulation improve outcomes or prevent recurrent stroke in patients with acute ischemic stroke?
Does emergent anticoagulation improve outcomes or prevent recurrent stroke in patients with acute ischemic stroke?
Emergent anticoagulation for acute ischemic stroke increases bleeding risk without clinical benefit, and is not recommended except for DVT/PE prophylaxis in bedridden patients.
Avoids routine emergent anticoagulation in acute ischemic stroke; confirms no benefit with excess bleeding and leaves open only DVT/PE prophylaxis.
BACKGROUND: Several clinical trials have tested the potential utility of emergent anticoagulation for acute ischemic stroke. SUMMARY OF REVIEW: Rather than performing a meta-analysis that combines the data from several trials, this review focuses on individual studies. Although these trials do have inherent limitations, they demonstrate that emergent use of an anticoagulant is associated with a modest but significantly increased risk of hemorrhagic transformation of the ischemic stroke or serious nonneurological bleeding. The trials do not demonstrate a benefit from emergent anticoagulation in improving outcome, reducing mortality, and preventing early recurrent stroke. CONCLUSIONS: These results suggest that most patients with acute stroke should not be treated with unfractionated heparin or other rapidly acting anticoagulants after stroke. Prevention of deep vein thrombosis and pulmonary embolism among bedridden patients is the only established indication for early anticoagulation after acute ischemic stroke.
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Harold P. Adams (2002) conducted a review in Acute ischemic stroke. Emergent anticoagulation was evaluated on Hemorrhagic transformation, serious nonneurological bleeding, mortality, and early recurrent stroke. Emergent anticoagulation for acute ischemic stroke does not improve outcomes or reduce mortality, but significantly increases the risk of hemorrhagic transformation and serious bleeding.
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