Anticoagulation Strategies in Ischemic Stroke: Evidence Based on Experimental Research

Summary

Anticoagulation has not been shown unequivocally to confer benefit to patients with TIAs, stroke-in-evolution, partial stable stroke, or completed stroke. One unconfirmed study of subcutaneous LMWH (nadroparin) applied in early stroke appears to reduce mortality at 6 months. Anticoagulation has been shown to significantly decrease the frequency of cerebral embolism in patients with a signal myocardial infarction, atrial fibrillation in the absence of a valvular abnormality, and mechanical cardiac valve prosthesis, or xenograft (bio)prostheses. The use of LMWH or low molecular weight heparinoids to reduce stroke-related disability and/or mortality is currently under rigorous study, although outcomes are conflicting. However, the contributions of fibrin and platelet deposition to microvascular occlusion following middle cerebral artery occlusion provides an experimental basis for considering the use of antithrombins to maintain microvascular patency and therefore potentially reduce tissue injury during acute focal cerebral ischemia.

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