تجويز هپارين استادارد و هپارينهاي با وزن مولكولي پايين در درمان سكته مغزي حاد ايسكميك

Unfractionated heparin and low molecular weight heparin in the treatment of acute ischemic stroke

Background: In spite of using anticoagulant drugs such as unfractionated heparin (UFH) and low molecular weight heparin (LMWH) in the treatment of acute ischemic stroke, the efficacy of them has not been documented. Regarding to the frequent administration of these drugs, the evaluation of efficacy, advantages, and hazards of them is much important. Methods: We reviewed articles about this type of treatment including randomized clinical trials, meta-analyses, original articles, systematic reviews and review articles published in MEDLINE and EMBASE during 1997-2003. Results: In the short- and long-term follow up, UFH and LMWH donʹt result in considerable decreasing mortality, progression of stroke and early relapse risk. They donʹt result in considerable improvement in clinical and functional status of patients. In spite of considerable decreasing of deep vein thrombosis (DVT) and pulmonary emboli (PE) by administration of UFH and LMWH, it is established that they increase risk of infra- or hemorrhage. There is no valid document that immediate administration of anticoagulants (particularly intravenous and high dose) has helpful outcome. Conclusion: UFH and LMWH are not recommended in the majority of cases with stroke particularly during the first 24-48 hours of attack. Subcutaneous administration of UFH and LMWH is helpful in preventing DVT and PE, while they increase risk of systemic and intracranial hemorrhages. Immediate treatment is not recommended in any type of cerebrovascular accident (CVA).