Comparison of the acute-phase response in patients with ischemic stroke treated with high-dose heparin or aspirin

Experimental studies have suggested that unfractionated heparin (UH) has an tiinflammatory properties. It is unknown whether UH also has these properti es in patients with acute ischemic stroke. Within 12-24 h of treatment onse t we measured the acute-phase response as reflected by the erythrocyte sedi mentation rate (ESR) and total number of leukocytes (x10(9)/l) in 706 conse cutive patients with acute ischemic stroke treated with full-dose UH (n=450 ), or 300 mg/day aspirin (n=256). Clinical outcome (Mathew scale) at hospit al discharge and the effect of factors such as treatment (UH and aspirin), and acute phase response were assessed using multivariate analyses adjusted for baseline confounders and incident complications. Separate models were created for patients with lacunar and nonlacunar stroke. Whereas there were not differences at baseline between the two treatment groups, total leukoc yte counts (8.0+/-4.1 vs. 8.6+/-3.2, P<0.01) and ESR (21.7+/-20.9 vs. 25.2/-22.9, P<0.05) were statistically significantly lower in patients treated with UH. This effect of UH was more accentuated in patients with nonlacunar stroke. Overall, leukocytes (7.2+/-2.3 vs. 8.4+/-4.0, P<0.01), and ESR (15 .7+/-17.2 vs. 24.3+/-22.2, P=0.0001) were lower in patients with complete e arly recovery and this effect was restricted to patients with nonlacunar st roke. Whereas baseline impairment, symptomatic bleeding and stroke recurren ce were independent negative outcome predictors, the use of UH was positive ly associated with early recovery in all patients. This study shows that fu ll-dose UH reduces the acute-phase reaction that follows ischemic stroke mo re effectively than aspirin. The prognostic implications of such effect see m more notable in patients with nonlacunar stroke. (C) 2000 Elsevier Scienc e BN. All rights reserved.