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Prevention of venous thromboembolism after acute ischaemic stroke

Paul Alexander Kyrle, Konrad Binder, Sabine Eichinger, Reinhold Függer, Bernd Gollackner, J Michael Hiesmayr, Kurt Huber, Wielfried Lang, Peter Perger, Peter Quehenberger, Franz X Roithinger, Sabine Schmaldienst, Ansgar Weltermann, Hans Domanovits
Dabigatran, a direct thrombin inhibitor, is licensed for the prevention of venous thromboembolism after knee and hip replacement, the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation and for the treatment of acute venous thromboembolism. As dabigatran has a favourable benefit-risk profile, it is being increasingly used. Dabigatran differs from vitamin K antagonists as regards its pharmacological characteristics and its impact on certain laboratory tests, and also in the lack of a direct antagonist that can reverse dabigatran-induced anticoagulation...
September 2014: Wiener Klinische Wochenschrift
William N Whiteley, Harold P Adams, Philip M W Bath, Eivind Berge, Per Morten Sandset, Martin Dennis, Gordon D Murray, Ka-Sing Lawrence Wong, Peter A G Sandercock
BACKGROUND: Many international guidelines on the prevention of venous thromboembolism recommend targeting heparin treatment at patients with stroke who have a high risk of venous thrombotic events or a low risk of haemorrhagic events. We sought to identify reliable methods to target anticoagulant treatment and so improve the chance of avoiding death or dependence after stroke. METHODS: We obtained individual patient data from the five largest randomised controlled trials in acute ischaemic stroke that compared heparins (unfractionated heparin, heparinoids, or low-molecular-weight heparin) with aspirin or placebo...
June 2013: Lancet Neurology
Ines C Kiphuth, Martin Köhrmann, Hagen B Huttner, Peter D Schellinger
Stroke is a common cause for morbidity and mortality, causing substantial economic costs. Because thrombosis plays a key role in the pathogenesis of ischaemic stroke, heparins, platelet inhibitors and anticoagulants have been used in stroke management. There were high hopes that patients might benefit from the use of heparins. Unfortunately, these expectations have not been met. Instead, thrombolytics have been shown to result in an improvement of outcome in a considerable fraction of patients with ischaemic stroke...
September 2009: Expert Opinion on Drug Safety
J L Mega, E Braunwald, S Mohanavelu, P Burton, R Poulter, F Misselwitz, V Hricak, E S Barnathan, P Bordes, A Witkowski, V Markov, L Oppenheimer, C M Gibson
BACKGROUND: Rivaroxaban is an oral direct factor Xa inhibitor that has been effective in prevention of venous thromboembolism in patients undergoing elective orthopaedic surgery. However, its use after acute coronary syndromes has not been investigated. In this setting, we assessed the safety and efficacy of rivaroxaban and aimed to select the most favourable dose and dosing regimen. METHODS: In this double-blind, dose-escalation, phase II study, undertaken at 297 sites in 27 countries, 3491 patients stabilised after an acute coronary syndrome were stratified on the basis of investigator decision to use aspirin only (stratum 1, n=761) or aspirin plus a thienopyridine (stratum 2, n=2730)...
July 4, 2009: Lancet
David G Sherman
Patients with stroke or transient ischemic attacks (TIAs) are at increased risk of vascular events, such as recurrent stroke or venous thromboembolism (VTE), and thus the secondary prevention of such events is an important element of managing these patients. Current guidelines recommend that patients with acute stroke, restricted mobility, and no contraindications to anticoagulants receive thromboprophylactic therapy with low-dose unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), or heparinoids to prevent VTE...
November 2006: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
David G Sherman, Gregory W Albers, Christopher Bladin, Cesare Fieschi, Alberto A Gabbai, Carlos S Kase, William O'Riordan, Graham F Pineo
BACKGROUND: Venous thromboembolism prophylaxis with low molecular weight heparin or unfractionated heparin is recommended in acute ischaemic stroke, but which regimen provides optimum treatment is uncertain. We aimed to compare the efficacy and safety of enoxaparin with that of unfractionated heparin for patients with stroke. METHODS: 1762 patients with acute ischaemic stroke who were unable to walk unassisted were randomly assigned within 48 h of symptoms to receive either enoxaparin 40 mg subcutaneously once daily or unfractionated heparin 5000 U subcutaneously every 12 h for 10 days (range 6-14)...
April 21, 2007: Lancet
J L Mas
Antithrombotic therapy should be considered in the acute phase of an ischaemic stroke in patients who are not candidates for thrombolysis. The recommended treatment is aspirin, 160 or 300 mg daily, associated in bed-ridden patients with prophylactic heparin therapy to avoid venous thromboembolic complications. Although not founded on scientific proof, high dose anticoagulants may be used instead of aspirin in special cases presumed to be at high risk of early recurrence of embolism or of extension of thrombosis...
November 2002: Archives des Maladies du Coeur et des Vaisseaux
A S Gallus
Clinical trials and meta-analyses have shown that low-molecular-weight heparin and unfractionated heparin are effective in preventing deep vein thrombosis (DVT) in acutely ill medical inpatients who are at risk as they are likely to be bedridden for 6 days or more. It is not known, however, if such prophylaxis can also reduce the likelihood of fatal pulmonary embolism or decrease all-causes mortality in this patient population. No recommendations can be made regarding thromboprophylaxis in those at a lower risk of venous thromboembolism or in short-stay inpatients, as these have not yet undergone clinical trial...
2000: Haemostasis
P Scholten, A Bever, K Turner, L Warburton
BACKGROUND: thrombo-embolic complications are important causes of morbidity and mortality after acute stroke. Anticoagulant prophylaxis is contraindicated in intracerebral haemorrhage and not recommended in acute ischaemic stroke because of increased risk of cerebral haemorrhage. Graduated elastic compression stockings are a simple alternative but are not widely used in stroke patients, perhaps because of perceived contraindications and problems with tolerability. OBJECTIVES: to establish the feasibility and tolerability of graduated compression stockings on a stroke unit...
July 2000: Age and Ageing
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