Alexander G.G. Turpie, MD; Michael Gent, DSc; Robert Côte, MD; Mark N. Levine, MD; Jeffrey S. Ginsberg, MD; Peter J. Powers, MD; Jacques Leclerc, MD; William Geerts, MD; Richard Jay, MD; Jean Neemeh, MD; Marian Klimek, BScN; Jack Hirsh, MD
▪ Objective: To compare the relative safety and efficacy of a low-molecular-weight heparinoid (ORG 10172) with unfractionated heparin in the prevention of deep vein thrombosis in patients with acute ischemic stroke.
▪ Design: Double-blind randomized trial.
▪ Setting: Seven Canadian university-affiliated hospitals.
▪ Participants: Eighty-seven patients with acute ischemic stroke resulting in lower-limb paresis.
▪ Intervention: Patients received either low-molecular-weight heparinoid, 750 anti-factor Xa units twice daily, or unfractionated heparin, 5000 units subcutaneously twice daily. Treatment was continued for 14 days or until hospital discharge if sooner.
▪ Measurements: Deep vein thrombosis was diagnosed using 125I-labeled fibrinogen leg scanning and impedance plethysmography. Venography was indicated if either test was positive. Overt hemorrhage, major or minor, was assessed clinically.
▪ Results: Venous thrombosis occurred in four patients (9%) given low-molecular-weight heparinoid and in 13 patients (31%) given heparin (relative risk reduction, 71%; 95% Cl, 16% to 93%. The corresponding rates for proximal vein thrombosis were 4% and 12%, respectively (relative risk reduction, 63%; P > 0.2). The incidence of hemorrhage was 2% in both groups.
▪ Conclusion: Low-molecular-weight heparinoid, given in a fixed dose of 750 anti-factor Xa units subcutaneously twice daily, is more effective than subcutaneous low-dose heparin for the prevention of deep vein thrombosis in patients with acute ischemic stroke.
Alexander G.G. Turpie, Michael Gent, Robert Côte, Mark N. Levine, Jeffrey S. Ginsberg, Peter J. Powers, et al. A Low-Molecular-Weight Heparinoid Compared with Unfractionated Heparin in the Prevention of Deep Vein Thrombosis in Patients with Acute Ischemic Stroke: A Randomized, Double-Blind Study. Ann Intern Med. 1992;117:353–357. doi: 10.7326/0003-4819-117-5-353
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Published: Ann Intern Med. 1992;117(5):353-357.
Neurology, Stroke, Venous Thromboembolism.
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