Immediate anticoagulation in acute focal brain ischemia revisited: gathering the evidence.

摘要: Several large randomized clinical trials (RCTs) have recently evaluated the efficacy and safety of “immediate” administration low-fixed-dose subcutaneous unfractionated heparin (UFH), medium-fixed-dose UFH, dalteparin, nadroparin, certoparin, tinzaparin, or danaparoid in patients with presumed acute ischemic stroke. A systematic review 23 427 anticoagulated within 2 weeks from onset symptoms disclosed that treatment was associated about 9 fewer recurrent strokes per 1000 treated, but it also a similar sized increase symptomatic intracranial hemorrhages.1 Disclaiming theoretical biological disadvantages highest bleeding rate found treated low-molecular-weight (LMWH) heparinoids. Nevertheless, some guidelines recommend immediate anticoagulation for at higher risk stroke recurrence, whereas delaying several days is preferred low early recurrence.2 Case-by-case consideration advocated by others, depending on underlying vascular mechanism, size location affected vessel, extent atherosclerotic process. Finally, Cochrane Investigators disregard any type anticoagulant stroke.1 The evidence …