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Widely Used Therapy May Not Be Effective In Treatment Of Acute Stroke

General use of anticlotting drugs, like low-molecular-weight (LMW) heparinoids, immediately after a stroke has little effect in producing a good outcome or in preventing a second stroke in most patients, according to the results of a large clinical trial published in the April 22, 1998, issue of The Journal of the American Medical Association. (1)

These results may bring about a change in the way the medical community treats stroke. For many years it has been common practice to administer anticoagulants to patients immediately after a stroke in an effort to limit brain injury and to prevent recurrent strokes. However, the results of this study show that, for most patients, this therapy may not work.

"If early treatment of acute ischemic stroke with an anticoagulant like heparin does not help," says Harold P. Adams, Jr., M.D., principal investigator of the study and a professor of neurology at the University of Iowa College of Medicine in Iowa City, "then we should be treating patients with other therapies."

The study, called the Trial of Org 10172 in Acute Stroke Treatment (TOAST), was a 7-year, randomized, double-blind, placebo-controlled, multi-center study of 1,281 acute stroke patients in 36 centers across the United States. TOAST, sponsored by the National Institute of Neurological Disorders and Stroke (NINDS), is the largest trial of an intravenously administered anticoagulant drug for treatment of acute ischemic stroke.

The purpose of the trial was to discover the effectiveness of LMW heparinoid (danaparoid/Org 10172) combined with conventional care in improving outcomes of stroke patients at 7 days and at 3 months after stroke in comparison to conventional therapy alone. Conventional or usual management includes individualized treatment recommended by a patient?s doctor, such as other medications, surgery, and/or rehabilitation including speech therapy or physical therapy.

The researchers found that at 7 days, patients
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Contact: Marcia Vital
301/496-5751
NIH/National Institute of Neurological Disorders and Stroke
21-Apr-1998


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