We evaluated the efficacy of low-molecular-weight heparin (LMWH) relative to aspirin in preventing early neurologic deterioration (END), venous thromboembolism (VTE), and outcomes at 6 months.
Patients were randomly assigned to receive either subcutaneous enoxaparin 4000 anti-factor Xa IU/0.4 mL twice daily or oral aspirin 200 mg daily for 10 days. After day 10, all subjects received aspirin 100 mg once daily for 6 months. We assessed whether LMWH was superior to aspirin in preventing END and VTE within the first 10 days after index stroke and evaluated 6-month outcomes.
Of the total 1368 patients, 7.89% suffered from END, and 2.85% suffered from deep-vein thrombosis during the first 10 days, with a significance difference between the LMWH group and aspirin group (3.95%, 1.46% versus 11.82%, 4.23%, respectively). At 6 months, there was a significant difference in the frequency of good outcomes among patients over the median age of 70 years (LMWH 63.8% versus aspirin 44.6%). The benefit of LMWH was also significant in patients with symptomatic stenosis of the posterior circulation and basilar artery (75.2% and 82% for LMWH versus 40.5% and 48% for aspirin, respectively).
For patients with acute ischemic stroke, treatment with LMWH within 48 hours of stroke until 10 days later may reduce END and deep-vein thrombosis during the first 10 days. LMWH appears to have advantages over aspirin in certain subgroups, such as elderly patients and patients with posterior circulation and basilar artery stenosis.
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Published online: March 21, 2014
Accepted: December 20, 2013
Received in revised form: December 17, 2013
Received: November 18, 2013
This study was supported by the Scientific Research Foundation of Zhejiang Province Health Department (2007A178).
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.