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- W2000560888 abstract "1also reflect those of individual trials and systematic reviews. 3–5 Treatment with subcutaneous and intravenous unfractionated heparin combined with low molecular weight heparins and heparinoids (LMWH)—a somewhat questionable approach—does not alter combined death and dependency for all ischaemic strokes (or constituent subtypes). Although anticoagulants may reduce early recurrence (except when LMWH was assessed alone), 3,4 this effect is counterbalanced by an increase in symptomatic intracranial haemorrhage. Both unfractionated heparin and LMWH significantly reduce venous thromboembolism (deep vein thrombosis [DVT] and PE). 3–5 Nevertheless, the AAN/ASA recommendations for the use of anticoagulation 1 can be challenged. The recommendation that subcutaneous heparins “may be considered for deep vein thrombosis prophylaxis in at-risk patients” is controversial. First, all patients with acute ischaemic stroke are at risk of DVT, although the risk is higher for some subgroups. This statement could therefore be interpreted to apply to most, if not all, patients. Second, the risk of symptomatic DVT in the absence of anticoagulation is now very low (absolute rate 1·1–1·8% 3,4 ). This may reflect the widespread use of alternative prophylactic measures, eg, adequate rehydration, aspirin, and early mobilisation. Third, anticoagulation increases symptomatic intracranial haemorrhage, which is fatal in about 50% of cases, hence the balance of risk and benefit may be adverse. Fourth, anticoagulation is relatively expensive when the cost of the drugs, administration, monitoring, and management of complications are taken into account. As a result, we need trials to test whether routine anticoagulation is beneficial and cost effective in preventing venous" @default.
- W2000560888 created "2016-06-24" @default.
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- W2000560888 date "2002-11-01" @default.
- W2000560888 modified "2023-09-23" @default.
- W2000560888 title "Anticoagulants and antiplatelet agents in acute ischaemic stroke" @default.
- W2000560888 cites W1969533355 @default.
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- W2000560888 doi "https://doi.org/10.1016/s1474-4422(02)00215-6" @default.
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