Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Treatment of Acute Ischemic Stroke: Open Trial With Continuous Intravenous Heparinization

Treatment of Acute Ischemic Stroke: Open Trial With Continuous Intravenous Heparinization Abstract • To determine safety of early anticoagulation in patients with acute ischemic stroke, 150 consecutive patients were treated with continuous intravenous heparinization for one to 17 days (median, seven days) in an open trial. Fourteen patients had transient ischemic attacks and 136 patients had acute cerebral infarctions (Cls). None of the patients with transient ischemic attacks experienced untoward events. Of those with acute CI, four patients (3%) suffered a new, or extension of, CI; six patients (4.4%) suffered hemorrhagic complications, four patients (3%) died during treatment, and six patients (4%) died afterwards. Three of the deaths were related to treatment complications. Only 13 patients (8.6%) experienced fluctuation of deficit. Median hospitalization was 25.5 days. Recovery of function was good to excellent in 81% of the patients with acute CI; 75% of the survivors were ambulatory, and about 66% of the patients had either a mild or a minimal neurologic deficit at discharge. The incidence of untoward events in patients with acute CI was high enough (7.4%) for us to conclude that the efficacy of continuous intravenous heparinization in acute ischemic stroke should be established with controlled studies before its routine use can be recommended. References 1. Farber JL, Chien KR, Mittnacht S Jr: The pathogenesis of irreversible cell injury in ischemia . Am J Pathol 1981;102:271-281. 2. Astrup J, Siesjo BK, Symon L: Thresholds in cerebral ischemia: The ischemic penumbra . Stroke 1981;12:723-725.Crossref 3. Raichle ME: The pathophysiology of brain ischaemia . Ann Neurol 1983;13:2-10.Crossref 4. Irino T, Watanabe M, Nishide M: Angiographical analysis of acute cerebral infarction followed by cascade-like deterioration of minor neurological deficits: What is progressing stroke? Stroke 1983;14:363-368.Crossref 5. Hedenius P: The use of heparin in internal disease . Acta Med Scand 1941;107:170-182.Crossref 6. Denber CB: Thrombose cerebrale et heparin . Schweiz Med Wochenschr 1945;75:192-195. 7. Rose WM: Anticoagulants in the management of cerebral infarction . Med J Aust 1950;1:503-504. 8. Fisher CM: The use of anticoagulants in cerebral thrombosis . Neurology 1958;8:311-332.Crossref 9. Carter AB: Anticoagulant treatment in progressing stroke , in Millikan CH, Siekert RG, Whisnant JP (eds): Cerebral Vascular Diseases: Third Princeton Conference . New York, Grune & Stratton, 1961, pp 151-159. 10. Fisher CM: Anticoagulant therapy in cerebral thrombosis and cerebral embolism . Neurology 1961;11:119-131.Crossref 11. Baker RN, Broward JA, Fang HC, et al: Anticoagulant therapy in cerebral infarction: Report on a cooperative study . Neurology 1962;12:823-835.Crossref 12. Whisnant JP: Discussion in progressing stroke: Anticoagulant therapy , in Millikan CH, Siekert RG, Whisnant JP (eds): Cerebral Vascular Diseases: Third Princeton Conference . New York, Grune & Stratton, 1961, pp 156-157. 13. Millikan CH: Anticoagulant therapy in cerebrovascular disease , in Millikan CH, Siekert RG, Whisnant JP (eds): Cerebral Vascular Diseases: Third Princeton Conference . New York, Grune & Stratton, 1961, pp 182-183. 14. Marshall J, Shaw DA: Anticoagulant therapy in cerebrovascular disease: A controlled trial . Lancet 1960;1:995-998.Crossref 15. Furlan AJ, Cavalier SJ, Hobbs RE, et al: Hemorrhage and anticoagulation after non-septic embolic brain infarction . Neurology 1982;32:280-282.Crossref 16. Kollar RL: Recurrent embolic cerebral infarction and anticoagulation . Neurology 1982;32:283-285.Crossref 17. Ruff RL, Dougherty JH: Evaluation of acute cerebral ischemia for anticoagulant therapy: Computed tomography or lumbar puncture . Neurology 1981;31:736-740.Crossref 18. Hakim AM, Furlan AJ, Hart RG, et al: Immediate anticoagulation of embolic stroke: A randomized trial . Stroke 1983;14:668-676.Crossref 19. Drake ME Jr, Shin C: Conversion of ischemic to hemorrhagic infarction by anticoagulant administration . Arch Neurol 1983;40:44-46.Crossref 20. Lodder J, van der Lugt PJM: Evaluation of the risk of immediate anticoagulation treatment in patients with embolic stroke of cardiac origin . Stroke 1983;14:42-46.Crossref 21. Ramírez-Lassepas M, Quiñones MR: Heparin therapy for stroke: Hemorrhagic complications and risk factors for intracerebral hemorrhage . Neurology 1984;34:114-117.Crossref 22. Ramírez-Lassepas M, Cipolle RJ, Rodvold KA, et al: Heparin-induced thrombocytopenia in patients with cerebrovascular ischemic disease . Neurology 1984;34:736-740.Crossref 23. Cipolle RJ, Seifert RD, Neilan BA, et al: Heparin kinetics: Variables related to disposition and dosage . Clin Pharmacol Ther 1981;29:387-393.Crossref 24. Millikan CH, Bauer RB, Goldschmidt J, et al: A classification and outline of cerebrovascular disease II . Stroke 1975;6:564-616.Crossref 25. Ringelstein EB, Zeumer H, Angelou D: The pathogenesis of strokes from internal carotid artery occlusion . Stroke 1983;14:867-875.Crossref 26. Allen CMC: Predicting the outcome of acute stroke: A prognostic score . J Neurol Neurosurg Psychiatry 1984;47:475-480.Crossref 27. Adams RD, Torvik A, Fisher CM: Progressing stroke: Pathogenesis , in Millikan CH, Siekert RG, Whisnant JP (eds): Cerebral Vascular Diseases: Third Princeton Conference . New York, Grune & Stratton, 1961, pp 133-150. 28. Jones HR, Millikan CH: Temporal profile (clinical course) of acute carotid system cerebral infarction . Stroke 1976;7:64-71.Crossref 29. Jones HR, Millikan CH, Sandok BA: Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction . Stroke 1980;11:173-177.Crossref 30. Patrick BK, Ramírez-Lassepas M, Snyder BD: Temporal profile of vertebrobasilar territory infarction . Stroke 1980;11:643-648.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Treatment of Acute Ischemic Stroke: Open Trial With Continuous Intravenous Heparinization

Loading next page...
 
/lp/american-medical-association/treatment-of-acute-ischemic-stroke-open-trial-with-continuous-X7rkvespZt

References (38)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1986.00520040066022
Publisher site
See Article on Publisher Site

Abstract

Abstract • To determine safety of early anticoagulation in patients with acute ischemic stroke, 150 consecutive patients were treated with continuous intravenous heparinization for one to 17 days (median, seven days) in an open trial. Fourteen patients had transient ischemic attacks and 136 patients had acute cerebral infarctions (Cls). None of the patients with transient ischemic attacks experienced untoward events. Of those with acute CI, four patients (3%) suffered a new, or extension of, CI; six patients (4.4%) suffered hemorrhagic complications, four patients (3%) died during treatment, and six patients (4%) died afterwards. Three of the deaths were related to treatment complications. Only 13 patients (8.6%) experienced fluctuation of deficit. Median hospitalization was 25.5 days. Recovery of function was good to excellent in 81% of the patients with acute CI; 75% of the survivors were ambulatory, and about 66% of the patients had either a mild or a minimal neurologic deficit at discharge. The incidence of untoward events in patients with acute CI was high enough (7.4%) for us to conclude that the efficacy of continuous intravenous heparinization in acute ischemic stroke should be established with controlled studies before its routine use can be recommended. References 1. Farber JL, Chien KR, Mittnacht S Jr: The pathogenesis of irreversible cell injury in ischemia . Am J Pathol 1981;102:271-281. 2. Astrup J, Siesjo BK, Symon L: Thresholds in cerebral ischemia: The ischemic penumbra . Stroke 1981;12:723-725.Crossref 3. Raichle ME: The pathophysiology of brain ischaemia . Ann Neurol 1983;13:2-10.Crossref 4. Irino T, Watanabe M, Nishide M: Angiographical analysis of acute cerebral infarction followed by cascade-like deterioration of minor neurological deficits: What is progressing stroke? Stroke 1983;14:363-368.Crossref 5. Hedenius P: The use of heparin in internal disease . Acta Med Scand 1941;107:170-182.Crossref 6. Denber CB: Thrombose cerebrale et heparin . Schweiz Med Wochenschr 1945;75:192-195. 7. Rose WM: Anticoagulants in the management of cerebral infarction . Med J Aust 1950;1:503-504. 8. Fisher CM: The use of anticoagulants in cerebral thrombosis . Neurology 1958;8:311-332.Crossref 9. Carter AB: Anticoagulant treatment in progressing stroke , in Millikan CH, Siekert RG, Whisnant JP (eds): Cerebral Vascular Diseases: Third Princeton Conference . New York, Grune & Stratton, 1961, pp 151-159. 10. Fisher CM: Anticoagulant therapy in cerebral thrombosis and cerebral embolism . Neurology 1961;11:119-131.Crossref 11. Baker RN, Broward JA, Fang HC, et al: Anticoagulant therapy in cerebral infarction: Report on a cooperative study . Neurology 1962;12:823-835.Crossref 12. Whisnant JP: Discussion in progressing stroke: Anticoagulant therapy , in Millikan CH, Siekert RG, Whisnant JP (eds): Cerebral Vascular Diseases: Third Princeton Conference . New York, Grune & Stratton, 1961, pp 156-157. 13. Millikan CH: Anticoagulant therapy in cerebrovascular disease , in Millikan CH, Siekert RG, Whisnant JP (eds): Cerebral Vascular Diseases: Third Princeton Conference . New York, Grune & Stratton, 1961, pp 182-183. 14. Marshall J, Shaw DA: Anticoagulant therapy in cerebrovascular disease: A controlled trial . Lancet 1960;1:995-998.Crossref 15. Furlan AJ, Cavalier SJ, Hobbs RE, et al: Hemorrhage and anticoagulation after non-septic embolic brain infarction . Neurology 1982;32:280-282.Crossref 16. Kollar RL: Recurrent embolic cerebral infarction and anticoagulation . Neurology 1982;32:283-285.Crossref 17. Ruff RL, Dougherty JH: Evaluation of acute cerebral ischemia for anticoagulant therapy: Computed tomography or lumbar puncture . Neurology 1981;31:736-740.Crossref 18. Hakim AM, Furlan AJ, Hart RG, et al: Immediate anticoagulation of embolic stroke: A randomized trial . Stroke 1983;14:668-676.Crossref 19. Drake ME Jr, Shin C: Conversion of ischemic to hemorrhagic infarction by anticoagulant administration . Arch Neurol 1983;40:44-46.Crossref 20. Lodder J, van der Lugt PJM: Evaluation of the risk of immediate anticoagulation treatment in patients with embolic stroke of cardiac origin . Stroke 1983;14:42-46.Crossref 21. Ramírez-Lassepas M, Quiñones MR: Heparin therapy for stroke: Hemorrhagic complications and risk factors for intracerebral hemorrhage . Neurology 1984;34:114-117.Crossref 22. Ramírez-Lassepas M, Cipolle RJ, Rodvold KA, et al: Heparin-induced thrombocytopenia in patients with cerebrovascular ischemic disease . Neurology 1984;34:736-740.Crossref 23. Cipolle RJ, Seifert RD, Neilan BA, et al: Heparin kinetics: Variables related to disposition and dosage . Clin Pharmacol Ther 1981;29:387-393.Crossref 24. Millikan CH, Bauer RB, Goldschmidt J, et al: A classification and outline of cerebrovascular disease II . Stroke 1975;6:564-616.Crossref 25. Ringelstein EB, Zeumer H, Angelou D: The pathogenesis of strokes from internal carotid artery occlusion . Stroke 1983;14:867-875.Crossref 26. Allen CMC: Predicting the outcome of acute stroke: A prognostic score . J Neurol Neurosurg Psychiatry 1984;47:475-480.Crossref 27. Adams RD, Torvik A, Fisher CM: Progressing stroke: Pathogenesis , in Millikan CH, Siekert RG, Whisnant JP (eds): Cerebral Vascular Diseases: Third Princeton Conference . New York, Grune & Stratton, 1961, pp 133-150. 28. Jones HR, Millikan CH: Temporal profile (clinical course) of acute carotid system cerebral infarction . Stroke 1976;7:64-71.Crossref 29. Jones HR, Millikan CH, Sandok BA: Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction . Stroke 1980;11:173-177.Crossref 30. Patrick BK, Ramírez-Lassepas M, Snyder BD: Temporal profile of vertebrobasilar territory infarction . Stroke 1980;11:643-648.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Apr 1, 1986

There are no references for this article.