Additional Studies

Fraxiparine in Ischemic Stroke Study

Death / Dependency at Six Months

	Placebo	LD	HD
Number	250	272	245
Death	68	73	73
Barthel <85	74	82	75
Combined	56.8%	57.2%	59.2%
Fraxiparine is the proprietary name for nadroparin Source: New England Journal of Medicine 1995 Dec 14;333(24):1588-1593

Heparin

Complications in Patients with Cerebrovascular Disease

• Symptomatic CNS hemorrhage in 1-4%
• Serious non-CNS hemorrhage in 2-3%

Sources:
Rothrock & Hart: Annals of  Internal  Medicine 1991; 115:885-895
Camerlingo et al: Archives of Neurology 1994; 51:462-467

Anticoagulant Treatment in Progressing Stroke

Unblinded, randomized trial of heparin (125 mg IV x1, IM q6H x 2) then phenindione PT 2-3x control for 3 weeks.  Number recovered or improved at 6 months:

• Control 19/38
• Anticoagulation 26/38 (p=.16)

Source: British Medical Journal 1961 2:70-73

Anticoagulant Therapy in Thrombosis in Evolution

Unblinded, randomized trial of heparin (50 mg IV q4h if < 1week until dicumarol therapeutic) then dicumarol for PT 15-25%.  Progression of deficit:

• 1 month - control 10/67 vs Rx 8/61
• 6 months - control 13/67 vs Rx 8/61
• 12 months - control 18/67 vs Rx 9/61

Source: Fisher, Neurology 1961 11:119-131, Baker et al, Neurology 1962 12:823-835

Heparin Treatment of Progressing Stroke-I

Prospective study of 36 patients who worsened after admission and were then treated with heparin for 7 hours to 21 days.  Further progression:

• Carotid 13/19
• Vertebrobasilar 2/8
• Lacunar 2/9

Source: Haley et al: Stroke 1988; 19:10-14

Heparin Treatment of Progressing Stroke-II

Retrospective chart review of 69 patients:

• 27 (39%) continued to deteriorate
• 2 due to CNS hemorrhage
• 12 (17%) stabilized
• 30 (44%) improved
• 10 (14%) developed hemorrhagic side effects

Source: Slivka & Levy, Stroke 1990; 21:1657-1662

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This presentation was written by Dr. William J. Powers, co-director of the Stroke Center at Barnes-Jewish Hospital and the Washington University School of Medicine.

Last Revised: March 26, 2001