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

receiving LMW heparinoid had a trend toward better recovery than did patients receiving only conventional therapy. However, by 3 months after stroke, the conventional therapy group had caught up with the anticoagulant group and both groups were doing equally well.

About 75 percent of patients in each group experienced a positive outcome at 3 months, a higher rate than that reported in other similar stroke trials. Patients reached a good outcome if they received a good score on two scales: a score of I or II on the Glasgow Outcome Scale and a score of 12 to 20 (out of 20) on the modified Barthel Index. The investigators noted worsening in the condition within the first week in about 10 percent of patients in both groups.

Less than two percent of patients in both groups had a recurrent stroke within the first week after the initial stroke. Thus, the urgency for treatment with anticoagulants to prevent recurrent stroke may not be as great as previously thought.

"Physicians need to reconsider when they should use heparin," says John Marler, M.D., a neurologist in the Division of Stroke, Trauma, and Neurodegenerative Disorders at the NINDS, "especially considering the availability of other acute stroke treatments."

The use of the LMW heparinoid may have a positive effect in a certain group of stroke patients, those with large artery atherosclerosis, a disease in which fatty materials (plaque) build up on the inside of the walls of large arteries, such as the large carotid arteries in the neck that carry the majority of blood to the brain. As part of the trial, the investigators established a guideline to classify different subtypes of ischemic stroke, such as strokes secondary to clots arising in the heart. This set of guidelines, called the TOAST Stroke Subtype Classification, is now widely used in other clinical stroke trials.

Stroke often results when blood clots form on the surface of the plaques in the arteries. The blood clot may cl

Contact: Marcia Vital
NIH/National Institute of Neurological Disorders and Stroke

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