Impact of Guidelines on Clinical Practice

Abstract

Background and Purpose-Since its introduction, controversy has existed about the administration of intravenous heparin for the treatment of acute ischemic stroke. We studied trends in the intravenous heparin use during a 6-year time period and the potential influence of clinical guidelines in national language on intravenous heparin administration in Korea. Methods-On the basis of a prospective nationwide multicenter stroke registry, we collected data on patients with acute ischemic stroke who arrived within 7 days of symptom onset during the time period 2008 to 2013. We studied patient demographics, prestroke medical history, stroke characteristics, and stroke treatment. Data from a total of 23 425 patients from 12 university hospitals or regional stroke centers were analyzed. Results-The administration of intravenous heparin steadily decreased throughout the study period: 9.7% in 2008, 10.9% in 2009, 9.4% in 2010, 6.0% in 2011, 4.7% in 2012, and 4.3% in 2013 (P for trend <0.001). The reduced intravenous heparin use was associated with moderate stroke severity, atrial fibrillation, and stroke of cardioembolic, other-, and undetermined etiology. In a multivariable logistic model, increase of 1 calendar year (odds ratio, 0.89; 95% confidence interval, 0.84-0.95; P<0.001) and release of clinical practice guidelines in Korean (odd ratio, 0.74; 95% confidence interval, 0.59-0.91; P<0.01) were independent factors associated with reduction in the frequency of intravenous heparin use. Conclusions-Use of intravenous heparin for acute ischemic stroke treatment has decreased in Korea, and this change may be attributable to the spread and successful implementation of regional clinical practice guidelines. (Stroke.

Perioperative stroke: pathophysiology and management

“…It could also increase complications like symptomatic hemorrhagic transformation or heparin-induced thrombocytopenia. Therefore, the use of intravenous unfractionated heparin has recently been decreased [ 65 ]. Given the high risk of bleeding complication, the use of intravenous heparin is not recommended for perioperative stroke.…”

David G. Sherman Lecture Award: 15-Year Experience of the Nationwide Multicenter Stroke Registry in Korea

“…Using registry data, it was shown that the use of intravenous heparin for the treatment of AIS decreased between 2008 and 2013 in South Korea, and this decrease might be attributable to the successful implementation of the stroke guidelines developed by the CRCS. 17…”

Review article: DOES INTRA-ARTERIAL HEPARIN FLUSHING (IAHF) CAN ACTUALLY INCREASE MANUAL MUSCLE TEST (MMT) SCORE IN CHRONIC ISCHEMIC STROKE PATIENTS?

“…There was no immediate, stepwise effect of new cientific information and national guidelines on clinical practice concerning heparin as treatment for progressive ischemic stroke (Eriksson et al 2010). The use of intravenous heparin for acute ischemic stroke treatment has decreased in Korea, and this change may be attributable to the spread and successful implementation of regional clinical practice guidelines (Chung et al 2016).…”