IMMEDIATE ANTICOAGULATION WITH HEPARIN FOR FIRST-EVER ISCHEMIC STROKEIN THE CAROTID-ARTERY TERRITORIES OBSERVED WITHIN 5 HOURS OF ONSET

Objective: To evaluate the safety and possible efficacy of heparin sod ium anticoagulation within 5 hours of the onset of first-ever nonlacun ar ischemic strokes in the internal carotid artery territories. Design : Pilot study, prospective and open. Setting: Inpatient stroke unit. P atients: Of 360 stroke patients observed during 13 months, 45 (12.5%) were included in the study. Interventions: Heparin sodium was administ ered intravenously, starting with a bolus of 10 000 U, followed by con tinuous infusion over 4 days at a rate adjusted to maintain an activat ed partial thromboplastin time ratio between 2 and 2.5. The mean inter val from stroke to treatment was 197 minutes. Results: Two patients ha d cerebral hemorrhage, one of which was fatal. None had extracranial m ajor bleeding, while six had minor bleeding. The conditions of 23 pati ents improved, 16 patients were stable, and six patients worsened by d ay 1, while 29 patients improved, eight patients were stable, and eigh t patients worsened by day 7. Six patients died by the first month and five more by the sixth month. Twenty-one patients were self-sufficien t, both at 1 and 6 months. Hemorrhagic complications were unrelated to any investigated factor. Multivariate analysis indicated that short-t erm outcome was predicted only by infarct size (P < .0001) and long-te rm outcome by infarct size (P = .002) and large vessel status (P = .02 35). Conclusions: Our study suggests that immediate heparin treatment for ischemic carotid stroke is feasible and generally safe and that pa tients whose conditions improve are those with smaller infarct size an d no evidence of large vessel obstruction.