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Abstract
The significance of low-molecular-weight heparins (LMWHs) in the management of acute stroke remains controversial. Previous randomized controlled trials (RCTs) have demonstrated superiority of LMWHs over unfractionated heparin (UFH), in the setting of acute ischemic stroke, as to the likelihood of occurrence of deep vein thrombosis, but there are too few data to provide reliable information on their effects on other important outcomes, including death and intracranial hemorrhage. Previous randomized trials have enrolled patients within 14 days of the onset of an acute ischemic stroke. However, few if any data exist on the neurological outcomes in patients with stroke in evolution presenting within 8 hours of symptom onset. The current study aims at assessing whether the early administration (in patients with stroke in evolution) of potentially more intensive antithrombotic therapy with Enoxaparin might reduce the risk of early recurrent ischemic strokes, death, and disability compared with UFH.
One hundred patients with acute ischemic stroke in evolution were enrolled (with symptoms of stroke within eight hours of randomization). Patients were randomized to receive UFH [5000 IU by IV bolus, followed by a continuous IV infusion] or Enoxaparin [0.5 mg per kilogram body weight subcutaneously every 12 hours]. All patients received 150 mg of oral aspirin daily. Therapy with UFH and Enoxaparin was continued for 10 days. The plasma concentrations of von Willebrand factor antigen were measured on admission and after 48 hours. National Institutes of Health Stroke Scale (NIHSS) and Computed Tomography (CT) imaging of the brain were performed in all patients at the time of admission and at regular intervals.