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

ose off the artery entirely or a piece of the clot may break off and travel to the brain (embolism). For many years, medications such as antiplatelets (for example, aspirin) and anticoagulants (for example, warfarin) have been used to prevent stroke in high-risk persons. However, the value of giving these medications to patients once a stroke had occurred was uncertain. Anticoagulants, such as heparin or danaparoid/Org 10172, prevent formation of clots and, because they act immediately, they might be helpful in an emergency situation such as stroke.

Unfortunately, heparin has potentially dangerous side effects, such as an increased risk of bleeding. The LMW heparins and heparinoids are newer anticoagulants which are effective in preventing deep vein thrombosis (large vein blood clots) in stroke patients and they appear safer than unfractionated heparin, an older form of heparin. Still, these newer agents also carry risks, primarily bleeding, especially in the area of the brain where the stroke occurred. In the TOAST trial, patients receiving the LMW heparinoid had a higher rate of bleeding than did patients who received conventional treatment alone.

The NINDS, one of the National Institutes of Health located in Bethesda, Maryland, is the nation?s leading supporter of research on the brain and nervous system and a lead agency for the Congressionally designated Decade of the Brain.

(1) Adams, H.P., Jr., Bendixen, B.H., Kappelle, L.J., Biller, J., Love, B.B., Gordon, D.L., Marsh, E.E., and the TOAST Investigators: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. Stroke 24: 35-41, 1993.


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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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