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December 11, 1995

Antithrombotic Therapy in Acute Ischemic Stroke

Author Affiliations

Edinburgh, Scotland

Arch Intern Med. 1995;155(22):2481. doi:10.1001/archinte.1995.00430220147017

In the January 23,1995, issue of the ARCHIVES, Becker and Ansell1 present a synopsis of the third American College of Chest Physicians Consensus Conference on Antithrombotic Therapy. In the clinical guidelines presented, they recommended the routine use of subcutaneous heparin therapy for the prevention of venous thromboembolism in patients with ischemic stroke. For the management of acute cardioembolic stroke, they recommend intravenous heparin. However, this advice is not supported by the available evidence. In a recent systematic review of 10 randomized controlled trials comparing anticoagulants with control (including about 1000 patients with acute presumed ischemic stroke), allocation to anticoagulant therapy was associated with a highly significant 81% reduction (P<.001 by two-tailed test) in the odds of deep venous thrombosis.2 However, there were insufficient data on the risk of death, intracranial hemorrhage, and functional outcomes to provide reliable evidence on the effect of treatment on these infrequent, but