PMID- 28374884
OWN - NLM
STAT- MEDLINE
DCOM- 20170726
LR  - 20220224
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 4
IP  - 4
DP  - 2017 Apr 4
TI  - Low-molecular-weight heparins or heparinoids versus standard unfractionated 
      heparin for acute ischaemic stroke.
PG  - CD000119
LID - 10.1002/14651858.CD000119.pub4 [doi]
LID - CD000119
AB  - BACKGROUND: Low-molecular-weight heparins (LMWHs) and heparinoids are 
      anticoagulants that may have more powerful antithrombotic effects than standard 
      unfractionated heparin (UFH) but a lower risk of bleeding complications. This is 
      an update of the original Cochrane Review of these agents, first published in 
      2001 and last updated in 2008. OBJECTIVES: To determine whether antithrombotic 
      therapy with LMWHs or heparinoids is associated with a reduction in the 
      proportion of people who are dead or dependent for activities in daily living 
      compared with UFH. SEARCH METHODS: We searched the Cochrane Stroke Group Trials 
      Register (last searched February 2017), the Cochrane Central Register of 
      Controlled Trials (CENTRAL: the Cochrane Library Issue 1, 2017), MEDLINE (1966 to 
      February 2017), and Embase (1980 to February 2017). We also searched trials 
      registers to February 2017: ClinicalTrials.gov, EU Clinical Trials Register, 
      Stroke Trials Registry, ISRCTN Registry and the World Health Organization (WHO) 
      International Clinical Trials Registry Platform. SELECTION CRITERIA: Unconfounded 
      randomised trials comparing LMWH or heparinoids with standard UFH in people with 
      acute ischaemic stroke, in which participants were recruited within 14 days of 
      stroke onset. DATA COLLECTION AND ANALYSIS: Two review authors independently 
      chose studies for inclusion, assessed risk of bias and trial quality, extracted 
      and analysed the data. Differences were resolved by discussion. MAIN RESULTS: We 
      included nine trials involving 3137 participants. We did not identify any new 
      trials for inclusion in this updated review. None of the studies reported data on 
      the primary outcome in sufficient detail to enable analysis for the review. 
      Overall, there was a moderate risk of bias in the included studies. Compared with 
      UFH, there was no evidence of an effect of LMWH or heparinoids on death from all 
      causes during the treatment period (96/1616 allocated LMWH/heparinoid versus 
      78/1486 allocated UFH; odds ratio (OR) 1.06, 95% CI 0.78 to 1.47; 8 trials, 3102 
      participants, low quality evidence). LMWH or heparinoid were associated with a 
      significant reduction in deep vein thrombosis (DVT) compared with UFH (OR 0.55, 
      95% CI 0.44 to 0.70, 7 trials, 2585 participants, low quality evidence). However, 
      the number of the major clinical events such as pulmonary embolism (PE) and 
      intracranial haemorrhage was too small to provide a reliable estimate of the 
      effects. AUTHORS' CONCLUSIONS: Treatment with a LMWH or heparinoid after acute 
      ischaemic stroke appears to decrease the occurrence of DVT compared with standard 
      UFH, but there are too few data to provide reliable information on their effects 
      on other important outcomes, including functional outcome, death and intracranial 
      haemorrhage.
FAU - Sandercock, Peter Ag
AU  - Sandercock PA
AD  - Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, The 
      Chancellor's Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB.
FAU - Leong, Tze Shin
AU  - Leong TS
AD  - University of Edinburgh, Edinburgh, UK.
LA  - eng
GR  - ETM/417/CSO_/Chief Scientist Office/United Kingdom
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20170404
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Heparinoids)
RN  - 9005-49-6 (Heparin)
SB  - IM
UOF - Cochrane Database Syst Rev. 2008 Jul 16;(3):CD000119. PMID: 18646059
MH  - Acute Disease
MH  - Anticoagulants/*therapeutic use
MH  - Brain Ischemia/drug therapy
MH  - Cause of Death
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Hemorrhage/chemically induced/epidemiology
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Heparinoids/*therapeutic use
MH  - Humans
MH  - Pulmonary Embolism/epidemiology
MH  - Randomized Controlled Trials as Topic
MH  - Stroke/*drug therapy/mortality
MH  - Venous Thrombosis/epidemiology
PMC - PMC6478133
COIS- Peter Sandercock: principal investigator of the International Stroke Trial. In 
      the distant past, he received Honoraria (paid to the department) and travel 
      expenses from a variety of pharmaceutical companies (including Organon) for 
      giving lectures at medical conferences. He is not involved in any contractual 
      consultancies with any company; he is not on the speakers panel of any company. 
      Tze Shin Leong: none known
EDAT- 2017/04/05 06:00
MHDA- 2017/07/27 06:00
PMCR- 2018/04/04
CRDT- 2017/04/05 06:00
PHST- 2017/04/05 06:00 [pubmed]
PHST- 2017/07/27 06:00 [medline]
PHST- 2017/04/05 06:00 [entrez]
PHST- 2018/04/04 00:00 [pmc-release]
AID - CD000119.pub4 [pii]
AID - 10.1002/14651858.CD000119.pub4 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2017 Apr 4;4(4):CD000119. doi: 
      10.1002/14651858.CD000119.pub4.