HEPARIN TREATMENT IN 52 PATIENTS WITH PROGRESSIVE ISCHEMIC STROKE

The clinical outcome and risk of hemorrhagic complications during heparin Heparin therapy and subsequent warfarin therapy were determined retrospectively in 52 Clinical outcome patients with ischemic stroke in progression. The mean age was 65 (range 42-81) years. Heparin was administered as intravenous bolus followed by infusion for 3-11 days. The mean dose was 27,800 (range 15,000-41,800) IU/24 h. 74% of all activated partial thromboplastin time values were within the therapeutic range (1.9-3.7 times the normal reference). During heparin therapy, progression of neurologic symptoms stopped in 38 patients (73%) of whom 20 experienced marked improvement. The effect was uncertain in 3 patients (6%), whereas 11 patients (21%) continued to deteriorate. Two patients with clinical worsening died. One of these patients developed an ischemic infarction, the other a hemorrhagic transformation. There were no other major complications. During subsequent warfarin therapy for 19.6 (range 0.3-60.2) months, thromboembolic stroke occurred in 4 patients (5.0 per 100 patient-years). There were 6 major hemorrhagic complications (7.5 per 100 patient-years) of which 2 were fatal (2.5 per 100 patient-years). The high rate of clinical improvement and the low rate of hemorrhagic complications suggest a benefit of heparin therapy in these patients, whereas the effect of subsequent warfarin therapy appears more dubious. In patients with ischemic progressive stroke, the effect of anticoagulant therapy should be compared with antiplatelet therapy in a prospective trial.