January 1, 2015Open 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

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).

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).

Study Design

Type

RCT (n=1,467)

Randomization

Computer-derived random sequences with sealed envelopes

Blinding

Open-label

Multicenter

Yes

PICO

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.

Intervention / Comparator

Dual antiplatelet therapy (DAT) or Low-molecular-weight heparin (LMWH) vs Aspirin alone (200 mg daily) (DAT: 200 mg aspirin + 75 mg clopidogrel daily; LMWH: 4,000 IU enoxaparin twice daily)

Primary Outcome

Incidence of early neurological deterioration (END) within 10 days after admission, p=<0.001

Main Result

Absolute Event Rate: 4.12% vs 14.81%

p-value: p=<0.001

Limitations

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

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.

Connected Papers

Building similarity graph...

Analyzing shared references across papers

Discussion

Authors

Xingyang Yi

Deyang Stomatological Hospital

Wanzhang Chi

Wenzhou Medical University

Chun Wang

Kunming University of Science and Technology

Journals

Journal of Clinical Neurology

Actions

Institutions

Wenzhou Medical University

Deyang Stomatological Hospital

References and Citations

Connected Papers

Building similarity graph...

Analyzing shared references across papers

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

Key Result

Study Design

PICO

Main Result

Limitations

Abstract

Citation Network

Connected Papers

Discussion

Authors

Journals

Actions

Institutions

References and Citations

Citation Network

Connected Papers

Discussion

Cite this study