The Case of Anticoagulation for Progressing Stroke

Most stroke neurologists of a certain age will recall being taught —or perhaps teaching—that the correct treatment for a patient with progressing stroke was to administer parenteral anticoagulation, typically intravenous heparin. This strategy had the advantage of being biologically plausible. Because stroke progression was most often due to clot progression, t hen anything anticlotting seemed intuitively sensible. Further support came from one of the first multicenter randomized clinical trials in vascular neurology. In 1961 and 1962, Fisher and Baker et al reported the results of a national cooperative study of anticoagulation in cerebral infarction. The results suggested a possible benefit to anticoagulation in patients with thrombosis in evolution, with patients receiving anticoagulation having about half the rate of progression of neurologic symptoms. There were limitations. The time window for inclusion was 8 weeks from symptom onset. There was no brain imaging. Participants within 7 days of onset were treated with a mix of intravenous heparin and the vitamin K antagonist dicoumarol, while those presenting later were treated with dicoumarol alone. Only 128 patients with thrombosis in evolution were included. Nevertheless, the idea of usin g anticoagulation for acute progressing stroke took hold.
Source: JAMA Neurology - Category: Neurology Source Type: research