Low-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischemic stroke (Cochrane review).

Main Results We included 5 trials involving 705 people. Four trials compared a heparinoid (danaparoid), and 1 compared an LMWH (enoxaparin) with standard UFH (Figures 1 and 2). Overall, 55/414 (13%) of the patients allocated danaparoid or enoxaparin had deep vein thrombosis (DVT) compared with 65/291 (22%) of those allocated UFH. This reduction was significant (odds ratio [OR] 0.52, 95% CI 0.56 to 0.79). However, the number of more major events (pulmonary embolism, death, intracranial or extracranial hemorrhage) was too small to provide a reliable estimate of more important benefits and risks. No data on recurrent stroke or functional outcome in survivors were available. Implications for Practice Clinicians who, despite the lack of evidence of overall benefit from routine anticoagulants in patients with acute ischemic stroke, still wish to use some form of anticoagulant regimen in selected patients with acute ischemic stroke should bear in mind the following: (1) The criteria to identify those few patients that might benefit from UFH, LMWH, or heparinoid have not been defined by these data. (2) Although LMWH and heparinoids appear to be more effective at preventing DVT (and possibly also pulmonary embolism) than UFH, their relative safety and costeffectiveness compared with UFH have not been established in patients with acute stroke.