Heparin in Acute Stroke With Atrial Fibrillation

Angel Chamorro, Nicolas Vila, Carlos Ascaso, Rosa Blanc
1999 Archives of Neurology  
The risk-benefit ratio of early vs late heparinization for acute stroke with nonvalvular atrial fibrillation remains unsettled. Objective: To clarify the relationship between timing to heparinization and functional outcome in acute cardioembolic stroke. Design: Consecutive case series. Setting: Referral center. Patients: In 231 patients with stroke and nonvalvular atrial fibrillation, intravenous or subcutaneous heparin administered with the goal of achieving an activated partial thromboplastin
more » ... time (APTT) 1.5 to 2.0 times control values. Delay to the initiation of heparin therapy was less than 6 hours from the onset of symptoms in 74 patients and between 6 and 48 hours in 157 patients. Functional outcome (Rankin scale) was assessed 9 ± 3 (mean ± SD) days from stroke onset using multivariate analysis and including in the model treatment delay, risk factors (eg, age, hypertension, diabetes, hypercholesterolemia, previous stroke, and heart disease), initial neurological severity, and baseline computed tomographic findings (eg, early signs of infarction and white matter abnormalities). Clinical symptoms on admission (Mathew score) and baseline radiological findings were evaluated in all subjects. The bleeding rate was assessed on subsequent computed tomographic (CT) scans (obtained 7 ± 2 days after stroke). The relationship between APTT ratios and stroke recurrence or hemorrhagic worsening was also tested. Main Outcome Measures: Functional outcome at hospital discharge and incidence of early recurrent strokes and bleeding complications.
doi:10.1001/archneur.56.9.1098 pmid:10488810 fatcat:7hnpwblzgfbyzjlk4fnmd6ev5m