HEPARIN TREATMENT OF RECENT TRANSIENT ISCHEMIC ATTACKS - A SAFETY STUDY

The risk of hemorrhagic complications and the clinical outcome during heparin and subsequent warfarin therapy was determined in 46 consecutive patients with recent transient ischemic attacks (TIAs). The mean age was 66.8 (range 42-87) years. Heparin was given intravenously for 2-9 days. The mean bolus and maintenance doses were 5,206 (range 0-10,000) IU and 1,000 (629-1.600) IU/h, respectively. Of all activated partial thromboplastin time values, the majority (72%) were within therapeutic range (1.9-3.7 times the normal reference). There were no hemorrhagic complications during heparin therapy. One patient suffered a minor stroke and 2 patients had recurrent TIAs. During a mean period of 12.6 (range 0.5-44.2) months of subsequent warfarin therapy, 2 patients suffered major hemorrhagic complications (2.0 per 100 patient-years), of which 1 was fatal. The rate of thromboembolic stroke was 2.0 per 100 patient-years. We conclude that immediate therapy with heparin in patients with recent TIAs is safe provided that the therapy is monitored accurately. The low rate of stroke and recurrent TIAs suggests that this therapy should be compared to aspirin in a randomized trial.