Background
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.
Methods
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.
Findings
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).
Conclusions
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.
Key Words
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Article info
Publication history
Published online: March 21, 2014
Accepted:
December 20,
2013
Received in revised form:
December 17,
2013
Received:
November 18,
2013
Footnotes
This study was supported by the Scientific Research Foundation of Zhejiang Province Health Department (2007A178).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.12.036
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
