Several recent comprehensive surveys have reviewed the theoretical and clinical evidence for heparin use in patients with acute thrombotic and embolic stroke.1-3 There is general agreement among the reviewers that the immediate administration of anticoagulation therapy is a reasonable course of action in many clinical situations, despite the well-recognized limitations of the data that are presently available. A typical scenario is that of a patient with a moderate deficit whose computed tomographic scan shows no evidence of intracerebral bleeding or large infarction. Such a patient might benefit from the immediate administration of anticoagulation therapy, because of the impossibility of predicting whether his or her condition will worsen (evolving stroke), and to prevent recurrence should it be determined that the stroke is the result of an embolus of cardiac origin.
At a recent conference, a protocol to test the efficacy of a new calciumchannel blocker in acute, middle cerebral
Sage JI. Stroke: The Use and Overuse of Heparin in Therapeutic Trials. Arch Neurol. 1985;42(4):315–317. doi:10.1001/archneur.1985.04060040025008
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