Differences Between Low-Molecular-Weight and Unfractionated Heparin for Venous Thromboembolism Prevention Following Ischemic Stroke

Shorr, Andrew F.; Jackson, William L.; Sherner, John; Moores, Lisa K.

doi:10.1378/chest.07-1826

Cited by 53 publications

(31 citation statements)

References 17 publications

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“…A meta-analysis 82 and a Cochrane systematic review of 9 trials involving 3137 subjects confirmed the superiority of LMWH over UFH. 83 Only 1 high-quality cost-effectiveness analysis comparing LMWH with UFH in acutely ill medical subjects (not stroke) demonstrated fewer complications with LMWH at a lower overall cost.…”

Section: Bmentioning

confidence: 90%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,169

840

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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Section: Bmentioning

confidence: 90%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,169

840

View full text Add to dashboard Cite

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“…В дальнейших исследованиях было продемонстрировано, что НМГ, по крайней мере, также эффективны, как и НФГ в профилактике ВТЭ у паци-ентов с острым ИИ. Они также обладают лучшей биодоступностью и более предсказуемым профилем антикоагулянтной активности по сравнению с НФГ [8][9][10]. В недавно проведенном исследовании Prevention of VTE after Acute Ischemic Stroke with LMWH (PREVAIL) было продемонстрировано, что низкомолекулярный гепарин -эноксапарин, предпочтительнее, чем НФГ для профилактики ВТЭ у пациентов с острым ИИ.…”

Section: Discussionunclassified

“…The following neurological outcomes were monitored: NIHSS scores at baseline, at Days 4,7,10, and 14 during hospitalization, at the end of study treatment, and at the 30-day and 90-day follow-up; stroke progression (defined as an increase in NIHSS score of Ն4 points from the lowest score obtained at any point from baseline to treatment period and follow-up into Day 90); neurological worsening attributable to stroke progression (defined as an increased NIHSS score in items reflecting worsening focal neurological deficits with or without concomitant worsening in items reflecting changes in the level of consciousness); stroke recurrence (defined as the development of new neurological deficits due to an event separate from the qualifying stroke and verified by CT scan or brain MRI); and mRS scores at baseline, end of study treatment, and at the 30-day and 90-day follow-up. For the analysis of stroke progression using the NIHSS score, patients were stratified according to the severity of the index stroke: a severe stroke was defined as an NIHSS score of Ն14, whereas a less severe stroke was defined as an NIHSS score of Ͻ14.…”

Section: Outcome Analysesmentioning

confidence: 99%

Neurological Outcomes in Patients With Ischemic Stroke Receiving Enoxaparin or Heparin for Venous Thromboembolism Prophylaxis

Kase

Albers

Bladin

et al. 2009

Stroke

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on behalf of the PREVAIL InvestigatorsBackground and Purpose-The Prevention of VTE after Acute Ischemic Stroke with LMWH (PREVAIL) study demonstrated that enoxaparin was superior to unfractionated heparin (UFH) in preventing venous thromboembolism in patients with ischemic stroke and was associated with a small but statistically significant increase in extracranial hemorrhage rates. In this PREVAIL subanalysis, we evaluate the long-term neurological outcomes associated with the use of enoxaparin compared with UFH. We also determine predictors of stroke progression. Methods-Acute ischemic stroke patients aged Ն18 years, who could not walk unassisted, were randomized to receive enoxaparin (40 mg once daily) or UFH (5000 U every 12 hours) for 10 days. Patients were stratified according to baseline stroke severity using the National Institutes of Health Stroke Scale score. End points for this analysis included stroke progression (Ն4-point increase in National Institutes of Health Stroke Scale score), neurological outcomes up to 3 months postrandomization (assessed using National Institutes of Health Stroke Scale score and modified Rankin Scale score), and incidence of intracranial hemorrhage. Results-Stroke progression occurred in 45 of 877 (5.1%) patients in the enoxaparin group and 42 of 872 (4.8%) of those receiving UFH. Similar improvements in National Institutes of Health Stroke Scale and modified Rankin Scale scores were observed in both groups over the 90-day follow-up period. Incidence of intracranial hemorrhage was comparable between groups (20 of 877 [2.3%] and 22 of 872 [2.5%] in enoxaparin and UFH groups, respectively). Baseline National Institutes of Health Stroke Scale score, hyperlipidemia, and Hispanic ethnicity were independent predictors of stroke progression. Conclusions-The clinical benefits associated with use of enoxaparin for venous thromboembolism prophylaxis in patients with acute ischemic stroke are not associated with poorer long-term neurological outcomes or increased rates of symptomatic intracranial hemorrhage compared with UFH. Key Words: intracerebral hemorrhage Ⅲ ischemic stroke Ⅲ venous thromboembolism V enous thromboembolism (VTE) is a clinically important complication after a stroke. Without VTE prophylaxis, up to 75% of patients with stroke are likely to develop deep vein thrombosis 1,2 ; pulmonary embolism accounts for up to 25% of early deaths after a stroke. 3 Therefore, VTE prophylaxis is recommended in consensus guidelines for the management of patients with acute ischemic stroke. 4 -6 Anticoagulation with unfractionated heparin (UFH) or a low-molecular-weight heparin (LMWH) is commonly prescribed to stroke patients to reduce the risk of VTE. In the International Stroke Trial (IST), UFH was shown to significantly reduce the incidence of pulmonary embolism and stroke recurrence in patients with acute ischemic stroke. Several studies have demonstrated that anticoagulation therapy with LMWHs or UFH does not adversely affect functional or neurological outcomes in patients wit...

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“…60,61 A recent meta-analysis of studies comparing prophylactic doses of LMWH and UFH found that use of LMWH after ischemic stroke was associated with a reduction in VTE without increased bleeding complications. 62 IPC may have an additional benefit when combined with anticoagulants in preventing VTE in stroke patients. 63 …”

Section: Venous Thromboembolismmentioning

confidence: 99%