DALTEPARIN IN ACUTE ISCHEMIC CEREBROVASCULAR-DISEASE - A SAFETY STUDY

We evaluated the safety and clinical effect of the low-molecular-weigh t heparin dalteparin in 60 consecutive patients with acute ischemic ce rebrovascular disease. The indication for dalteparin therapy was stabl e cardioembolic stroke in 24 patients, stroke in progression in 23 pat ients, and serious and frequent TIAs or TIAs despite aspirin in 13 pat ients. The mean age was 73.0 years (49-85). After exclusion of hemorrh age by cerebral CT scan, dalteparin therapy was started 39 h (2-168) a fter onset of symptoms. Dalteparin was administered as subcutaneous in jections 100 IU/kg body weight every 12 h with a mean daily dose of 13 ,533.4 IU and a mean duration of 8.7 days (3-16). In patients with TIA s and cardioembolic stroke, there were no further cerebrovascular epis odes or clinical deterioration. Clinical worsening occurred in a total of 6 patients (10%), all 6 included because of progressive stroke. Ce rebral CT excluded hemorrhagic transformation as reason for deteriorat ion. A second CT was done in all patients after a mean duration of 7.8 days (5-11) of dalteparin therapy and revealed asymptomatic hemorrhag ic transformation in 3 patients (5.0%). All these 3 patients had taken aspirin prior to dalteparin therapy. There was no clinical significan t decrease in hemoglobin values or platelet count during dalteparin th erapy. We conclude that anticoagulant therapy with weight-adjusted dos es of the low-molecular-weight heparin dalteparin in patients with acu te ischemic cerebrovascular disease is safe in this setting and that t he clinical effect should be studied in randomized trials.