Is enoxaparin superior to unfractionated heparin for the prevention of thromboembolism after ischaemic stroke?  

Oleh:

Adam, Harold P.

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Medical Progress vol. 34 no. 11 (Nov. 2007), page 526.

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Perpustakaan FK Nomor Panggil: M36.K.2007.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Background : To evaluate the efficacy and safety of unfractionated heparin and of enoxaparin for the prevention of venous thromboembolism (VTE) in opatients withacute ischaemic stroke. Design : This non-blinded, randomized trial enrolled patients with acute ishaemic stroke age 18 years or older. Patients had an INH stroke scale (NIHSS) score of 2 or more for leg motor function and required assistance walking. Within 48 hours of symptom onset, patients were randomly assigned to recieved either 40 mg/day enoxaparin subcutaneously or 5,000 U heparin every 12 hours subcutaneously for an everage of 10 days (range 6-14 days). All accurences of the efficacy endpoint were confirmed by bilateral contrast venography, ultrasonography, ventilation perfusion scanning, thoracic helical CT scanning, or autopsy. Result : Between Agust 2003 and april 2006, a total of 1,762 patients were enrolled from centres in 15 countries across six continents. After exclusions, 1,335 patients (enoxaparin=666; unfractionated heparin=669) commenced treatment. After 14 dats of follow up. tgere were fewer occurrences of VTE among patients who received enoxaparin than among those in the unfractionated heparin group (relative risk [RR] 0.57, 95% CL 0.44-0.76; p=0,0001), and this reduction in VTE frequncy was sustained at 30,60 and 90 days (11% vs 18%; p<0.0001 for all). For both treatment groups, incidence of VTE was higher in patients with severe stroke (NIHSS score >14) than in those with less severe stroke (NIHSS score<14), but the reduction in risk associated with enoxaparin was significant or both (NIHSS score <14: RR 0.59, 95% CI 0.41-0.85, p=0.0043; NIHSS score >14: RR 0.55, 95% CI 0.36-0.83, p=0.00036). There were no significant differences between the two treatment groups in the incidences of all cause mortality, bleeding, or symptomayic intracranial hemorrhage.Enoxaparin was, however, associted with a higher rate of major extracranial haemorrhage than unfractionated heparin; the difference was significant in patients with NIHSS score of 14 or more (p=0,04). Conclusion : Enoxaparin is superior to unfractionated heparin for the prevention of VTE in patients with acute ischaemic stroke but is associated with an increased risk of major extracranial haemorrhage.

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