PMID- 16674999
OWN - NLM
STAT- MEDLINE
DCOM- 20070405
LR  - 20071115
IS  - 0049-3848 (Print)
IS  - 0049-3848 (Linking)
VI  - 119
IP  - 3
DP  - 2007
TI  - What is the optimal pharmacological prophylaxis for the prevention of deep-vein 
      thrombosis and pulmonary embolism in patients with acute ischemic stroke?
PG  - 265-74
AB  - BACKGROUND: Pulmonary embolism after acute ischemic stroke (AIS) is associated 
      with a high in-hospital mortality. The benefit from pharmacological prophylaxis 
      for venous thromboembolism (VTE) is uncertain probably due to doubts about the 
      optimal agent and dose. We evaluated the benefit/risk ratio of different 
      anticoagulant regimens in the prevention of VTE in patients with AIS. METHODS: 
      The MEDLINE, EMBASE, and Cochrane Library databases were searched up to January 
      2005. Randomized controlled trials (RCT) comparing early administration of either 
      low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) with control 
      were included. Endpoints were objectively diagnosed deep-vein thrombosis (DVT), 
      pulmonary embolism, intracranial hemorrhage (ICH), and extracranial hemorrhage 
      (ECH). Low-dose UFH was arbitrarily defined as < or =15,000 IU/day, low-dose LMWH 
      as < or =6000 IU/day or weight-adjusted dose of < or =86 IU/kg/day. RESULTS: 
      Sixteen trials involving 23,043 patients with AIS met the inclusion criteria. The 
      number of events was small and different doses of anticoagulant treatment were 
      used. Compared to control, high-dose UFH was associated with a reduction in 
      pulmonary embolism (OR=0.49, 95% confidence interval (CI)=0.29-0.83), but also 
      with an increased risk of ICH (OR=3.86, 95% CI=2.41-6.19) and ECH (OR=4.74, 95% 
      CI=2.88-7.78). Low-dose UFH decreased the thrombosis risk (OR=0.17, 95% 
      CI=0.11-0.26), but had no influence on pulmonary embolism (OR=0.83, 95% 
      CI=0.53-1.31); the risk of ICH or ECH was not statistically significant increased 
      (OR=1.67, 95% CI=0.97-2.87 for ICH; and OR=1.58, 95% CI=0.89-2.81 for ECH, 
      respectively). High-dose LMWH decreased both DVT (OR=0.07, 95% CI=0.02-0.29) and 
      pulmonary embolism (0.44, 95% CI=0.18-1.11), but this benefit was offset by an 
      increased risk for ICH (OR=2.01, 95% CI=1.02-3.96) and ECH (OR=1.78, 95% 
      CI=0.99-3.17). Low-dose LMWH reduced the incidence of both DVT (OR=0.34, 95% 
      CI=0.19-0.59) and pulmonary embolism (OR=0.36, 95% CI=0.15-0.87), without an 
      increased risk of ICH (OR=1.39, 95% CI=0.53-3.67) or ECH (OR=1.44, 95% 
      CI=0.13-16). For low-dose LMWH, the numbers needed to treat were 7 and 38 for DVT 
      and pulmonary embolism, respectively. CONCLUSIONS: Indirect comparison of low and 
      high doses of UFH and LMWH suggests that low-dose LMWH have the best benefit/risk 
      ratio in patients with acute ischemic stroke by decreasing the risk of both DVT 
      and pulmonary embolism, without a clear increase in ICH or ECH.
FAU - Kamphuisen, Pieter W
AU  - Kamphuisen PW
AD  - Stroke Unit and Division of Internal and Cardiovascular Medicine, University of 
      Perugia, Perugia, Italy. kamphuisen.botermans@planet.nl
FAU - Agnelli, Giancarlo
AU  - Agnelli G
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20060503
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - *Brain Ischemia/complications/mortality
MH  - Dose-Response Relationship, Drug
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Hospital Mortality
MH  - Humans
MH  - Pulmonary Embolism/etiology/mortality/*prevention & control
MH  - Randomized Controlled Trials as Topic
MH  - Risk Factors
MH  - *Stroke/complications/mortality
MH  - Treatment Outcome
MH  - Venous Thrombosis/etiology/mortality/*prevention & control
RF  - 33
EDAT- 2006/05/06 09:00
MHDA- 2007/04/06 09:00
CRDT- 2006/05/06 09:00
PHST- 2005/08/30 00:00 [received]
PHST- 2006/03/22 00:00 [revised]
PHST- 2006/03/22 00:00 [accepted]
PHST- 2006/05/06 09:00 [pubmed]
PHST- 2007/04/06 09:00 [medline]
PHST- 2006/05/06 09:00 [entrez]
AID - S0049-3848(06)00115-0 [pii]
AID - 10.1016/j.thromres.2006.03.010 [doi]
PST - ppublish
SO  - Thromb Res. 2007;119(3):265-74. doi: 10.1016/j.thromres.2006.03.010. Epub 2006 
      May 3.