Additional Studies and Conclusions

Cerebral Embolism Study Group

Un-blinded, prospective randomized study of clinically diagnosed cardio-embolic stroke within 48 hours treated with heparin for 48 hours then warfarin.  Results at 14 days:

• Stroke - control 2/21 vs Rx 0/24
• Death - control 2/21 vs Rx 0/24

Source: Stroke 1983; 14:668-670-1662

International Stroke Trial

> Atrial Fibrillation

Trial of ORG 10172 in Acute Stroke Treatment (TOAST)

> Cardioembolism

Retrospective Stroke Subtype Analysis

• Five subtypes analyzed for two different endpoints in addition to 4 analyses for total group = 14 analyses
  p < .05/14 = p< .0036
• Large artery atherosclerosis
  Favorable outcome p=.04
  Very favorable outcome p=.02
• No significant difference

Cardiac Embolism Conclusions

• IST showed no benefit for the subgroup with atrial fibrillation
• TOAST showed no benefit for the subgroup with cardioembolism

Summary

Patients with lower extremity paralysis should receive DVT prophylaxis with low dose anticoagulation.  Anticoagulation with heparin or heparin like drugs has no beneficial effect on:

• Progression or early recurrence
• Long term functional status
• Any subgroup of patients

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References

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