Double-Blind Randomised Trial of Org 10172 Low-Molecular-Weight Heparinoid in Prevention of Deep-Vein Thrombosis in Thrombotic Stroke

Turpie, A. G. G.; Hirsh, Jack; Jay, RichardM; Andrew, Maureen; Hull, R. D.; Levine, Mark; Carter, CedricJ; Powers, P.; Magnani, H N; Gent, Michael

doi:10.1016/s0140-6736(87)90173-5

Cited by 195 publications

(54 citation statements)

References 15 publications

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“…Three percent of stroke patients succumb to PE within 3 months, 18 a mortality confined to the half who develop DVT. 1 Because one third of these DVTs are proximal 2 and most are silent, 1 the data suggest that the mortality associated with untreated proximal subclinical DVT after stroke is some 15%, which is similar to that in postoperative patients.…”

Section: Clinical Significance Of Asymptomatic Proximal Dvt After Strokementioning

confidence: 98%

Venous Thromboembolism After Acute Stroke

Kelly

Rudd

Lewis

et al. 2001

Stroke

223

165

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Background-Treatment for venous thromboembolism (VTE) is highly effective in preventing morbidity and mortality, yet pulmonary embolism (PE) accounts for up to 25% of early deaths after stroke. This is because the current diagnostic paradigm is reactive rather than proactive: the clinician responds to VTE when it becomes symptomatic, in the expectation that initiation of treatment will prevent progression to more serious manifestations. This approach is flawed, because sudden death from PE is frequently unheralded and nonfatal symptomatic pulmonary emboli are often unrecognized or misdiagnosed. Summary of Comment-Morbidity and mortality from PE could be reduced either by more effective thromboprophylaxis or earlier diagnosis and treatment of established VTE. The fact that early use of short-term, low-dose, unfractionated heparin (UFH) is not associated with sustained, clinically meaningful benefit suggests that a fundamental change in the diagnostic approach to VTE is needed, one which requires a greater appreciation that clinically apparent events are merely the tip of the thromboembolism iceberg. Conclusions-Research into a strategy of screening for subclinical VTE in these patients is needed, with a view to identifying a subgroup at risk of progression to symptomatic and life-threatening events, in whom outcome might be improved by anticoagulation. (Stroke. 2001;32:262-267.)

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Section: Clinical Significance Of Asymptomatic Proximal Dvt After Strokementioning

confidence: 98%

Venous Thromboembolism After Acute Stroke

Kelly

Rudd

Lewis

et al. 2001

Stroke

223

165

View full text Add to dashboard Cite

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“…After scanning titles and abstracts, 743 citations were excluded and 23 were retained for further evaluation. Eighteen studies were excluded for the following reasons: data on cardioembolic strokes were not reported in 9 trials 8 -16 ; one trial did not have a control group 17 ; 2 trials were nonrandomized 18,19 ; randomization was performed after 48 hours from onset in 2 trials 20,21 ; cardioembolic strokes were excluded in 3 trials [22][23][24] ; and no computed tomography scan before randomization was performed in one trial. 25 Two studies were reincluded in the analysis because the authors provided us with data on cardioembolic strokes not previously reported in the original published articles.…”

Section: Study Selectionmentioning

confidence: 99%

Efficacy and Safety of Anticoagulant Treatment in Acute Cardioembolic Stroke

Paciaroni

Agnelli

Micheli

et al. 2007

Stroke

290

154

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Background and Purpose-The role of anticoagulant treatment for acute cardioembolic stroke is uncertain. We performed an updated meta-analysis of all randomized trials to obtain the best estimates of the efficacy and safety of anticoagulants for the initial treatment of acute cardioembolic stroke. Methods-Using electronic and manual searches of the literature, we identified randomized trials comparing anticoagulants (unfractionated heparin or low-molecular-weight heparin or heparinoids), started within 48 hours, with other treatments (aspirin or placebo) in patients with acute ischemic cardioembolic stroke. Two reviewers independently selected studies and extracted data on study design, quality, and clinical outcomes, including death or disability, all strokes, recurrent ischemic stroke, and cerebral symptomatic bleeding. Odds ratios for individual outcomes were calculated for each trial and data from all the trials were pooled using the Mantel-Haenszel method. Results-Seven

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“…1,2 Incidence of DVT during the first 2 weeks after stroke has been reported at between 27% and 75% among untreated control patients in several randomized prophylaxis trials. 3 The incidence and clinical impact of DVT during the chronic rehabilitation phase following stroke are, however, less well appreciated.…”

Section: Introductionmentioning

confidence: 99%

Deep Venous Thrombosis in Stroke Patients during Rehabilitation Phase

Hara

2008

Keio J. Med.

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Abstract. Purpose: The purpose of this study was to examine the incidence, factors, and effects of antiplatelet and anticoagulant agents on sub-acute and chronic ischemic stroke patients during the rehabilitation phase for rates of deep venous thrombosis (DVT) from the perspective for rehabilitation medicine.Methods: In this study of 272 patients undergoing rehabilitation for completed cerebral infarction, multiple circumference measurements of calf and thigh along with presence or absence of symptoms (congestion, swelling, skin redness, warmth, pain, pigmentation, fever and/or Homan sign or Luck's sign) documented in the physical examination were recorded in all patients. Patients with these symptoms suggestive of DVT were included for D-dimer assay and venous duplex ultrasonography to confirm presence of DVT.Results: DVT was documented in 24 patients (8.8%), most of whom displayed distal DVT on the hemiparetic side. A significant association was seen between occurrence of DVT and more severe lower limb paresis, manifesting as gait disturbance, severe calf muscle spasticity, use of ankle-foot orthosis (AFO). A significant increase in development of DVT was associated with severe spasticity in hemiparetic calf muscles (odds ratio (OR) 28.2; 95% confidence interval (CI), 6.9-113.5). Cilostazol seemed to be the only effective antiplatelet drug for preventing DVT in cerebral infarction patients.Conclusion: Incidence of DVT in the rehabilitation phase following stroke was not low, which was predominant as distal DVT on the hemiparetic side. Lower limb paresis, gait disturbance, calf muscle spasticity and use of AFO contributed to occurrence of DVT. It is likely that micro-injuries in the venous endothelium due to spasticity and AFO might cause DVT. Cilostazol seems effective for protecting against venous endothelial damage following DVT. (Keio J Med 57 (4) : 196 -204, December 2008)

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Double-Blind Randomised Trial of Org 10172 Low-Molecular-Weight Heparinoid in Prevention of Deep-Vein Thrombosis in Thrombotic Stroke

Cited by 195 publications

References 15 publications

Venous Thromboembolism After Acute Stroke

Venous Thromboembolism After Acute Stroke

Efficacy and Safety of Anticoagulant Treatment in Acute Cardioembolic Stroke

Deep Venous Thrombosis in Stroke Patients during Rehabilitation Phase

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