The article by Haring et al1 in the January issue of the Archives was rather shocking in my opinion. It could have as well read "And by the way, we put all our meningitis patients on full-dose heparin, doesn't everybody?" They then conclude that the heparinization was one strategy "that seemed to account for the favorable outcomes in our patients."1 They cannot conclude that on the basis of any data presented in their article.
The use of heparin to prevent stroke in suppurative meningitis must, certainly, be characterized as experimental. The article gave the most cursory discussion to the rationale for this therapy. Practitioners would be quite wrong, in my opinion, to draw the conclusion from this article that it is a reasonable "empirical" therapy in bacterial meningitis to prevent stroke.
Bacterial meningitis most often occurs in the setting of an associated systemic sepsis. The risks of heparinization
Goldman HB. Is Heparin Really Indicated in Bacterial Meningitis? Arch Neurol. 1994;51(1):13. doi:https://doi.org/10.1001/archneur.1994.00540130019008
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