Effectiveness of heparin treatment for progressing ischaemic stroke: Before and after study

Abstract

Objectives. During the acute phase of stroke, symptoms progress in 25% of patients, resulting in a worse outcome. Could heparin treatment improve the situation? Design. Before and after study. During the first period, no treatment was given to patients with progress of symptoms, whereas heparin was used regularly in the second period. A comparison of outcome was performed. Setting. Patients with acute stroke cared for in stroke units of two big emergency hospitals in Stokcholm. Besides heparin treatment, the groups were taken care of according to the same basic principles. Subjects. Consecutive patients admitted to a stroke unit during two periods of time. The first study comprised 314 patients with ischaemic stroke and the second 907. Intervention. In the treatment period, patients with ischaemic stroke and objectively recognized progression received heparin infusion for at least 5 days. Main outcome measures. Continued progression, length of stay, unaided walking at discharge, discharge destination and mortality. Results. The progression rate was non-significantly higher in the first period: 28 vs. 21%. One-third continued to progress regardless of treatment given. Patients with progression, treated and untreated alike, had 40% longer stay in the stroke unit compared with stable patients, whereas mortality was unaffected. Treatment did not reduce the proportion of patients who needed aid for walking at discharge (77 vs. 74%) or those who needed further institutionalized care (65 vs. 66%). Conclusion. Progression of focal stroke symptoms still constitutes a serious clinical problem for which heparin has insufficient effectiveness in clinical practice. New therapies, ideally preventive, are needed.