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.
Turpie AG, Gent M, Côte R, Levine MN, Ginsberg JS, Powers PJ, 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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