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Controversies in Neurology
September 1999

Is There Still a Role for Intravenous Heparin in Acute Stroke?Yes

Author Affiliations

From the Neurology Department, University of Heidelberg, Heidelberg, Germany.

 

VLADIMIRHACHINSKIMD, FRCPC, DSC

Arch Neurol. 1999;56(9):1159-1160. doi:10.1001/archneur.56.9.1159

INTRAVENOUS (IV) heparin was frequently considered a treatment option in acute ischemic stroke. However, only limitation of thrombus growth and facilitation of spontaneous endogenous thrombolysis are reasons to believe in its value in treating the index stroke. Most clinicians nowadays agree that the use of heparin, either IV or subcutaneously (SC), prevents deep venous thrombosis and pulmonary embolism.1However, the question remains whether heparin does prevent recurrent stroke. In view of the potential hemorrhagic complications and heparin-induced thrombocytopenia, early treatment with IV heparin has always been a matter of controversy. In 1994, the Stroke Council of the American Heart Association did not recommend heparin because data about safety and efficacy were insufficient and conflicting.1Nevertheless, in the absence of other acute treatment options and with proved primary and secondary preventive effects of oral anticoagulation in cardioembolic stroke, IV heparin was frequently applied in several parts of the world.

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