Venous thromboembolism prevention with low molecular weight heparin may reduce hemorrhagic transformation in acute ischemic stroke
- 24.03.2020
- Original Article
Erschienen in:
- Verfasst von
- Antonio Muscari
- Elena Bartoli
- Luca Faccioli
- Elena Franchi
- Marco Pastore Trossello
- Giovanni M. Puddu
- Luca Spinardi
- Marco Zoli
- Erschienen in
- Neurological Sciences | Ausgabe 9/2020
Abstract
Background
Subcutaneous heparin at a prophylactic dose (SHPD) is a rather common treatment in ischemic stroke, but whether it confers an increased risk of hemorrhagic transformation of cerebral infarct (HT) and whether its reduction or discontinuation favors HT regression are presently poorly understood.
Methods
Two samples of ischemic stroke patients with a cerebral lesion diameter ≥ 3 cm on brain CT scan, admitted over 7 years to our stroke unit, were retrospectively examined: (1) patients treated or not treated with SHPD (enoxaparin 4000 U/day), with subsequent assessment of possible HT appearance (N = 267, mean age 75.9 ± 12.8 years) and (2) patients treated with SHPD, with HT and subsequent reduction/discontinuation or maintenance of the initial dose, and subsequent assessment of HT evolution (N = 116, mean age 75.7 ± 11.1 years). HT severity was quantified according to the ECASS study (HT score).
Results
In the first sample, after adjustment for age, sex, stroke severity, cerebral lesion diameter, and other possible confounders, SHPD was inversely associated with HT appearance (hazard ratio 0.62, 95% CI 0.39–0.98, P = 0.04). In the second sample, after adjustment for age, sex, stroke severity, cerebral lesion diameter, and initial HT severity, SHPD reduction/discontinuation had an inverse effect on both HT score improvement (odds ratio 0.42, 95% CI 0.18–0.99, P = 0.049) and HT improvement according to neuroradiological reports (odds ratio 0.34, 95% CI 0.14–0.82, P = 0.015).
Conclusions
This retrospective study suggests that SHPD may play a protective role in HT appearance and evolution, which requires verification by a randomized clinical trial.
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- Titel
- Venous thromboembolism prevention with low molecular weight heparin may reduce hemorrhagic transformation in acute ischemic stroke
- Verfasst von
-
Antonio Muscari
Elena Bartoli
Luca Faccioli
Elena Franchi
Marco Pastore Trossello
Giovanni M. Puddu
Luca Spinardi
Marco Zoli
- Publikationsdatum
- 24.03.2020
- Verlag
- Springer International Publishing
- Erschienen in
-
Neurological Sciences / Ausgabe 9/2020
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478 - DOI
- https://doi.org/10.1007/s10072-020-04354-0
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