Short-Term and Long-Term Safety and Efficacy of Treatment of Acute Ischemic Stroke with Low-Molecular-Weight Heparin: Meta-Analysis of 19 Randomized Controlled Trials.

Yi Ye, Wenqin Zhou, Wenke Cheng, Yanmin Liu, Rong Chang

World neurosurgery 2020 Sep

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Currently, it remains controversial about guidelines for the application of low-molecular-weight heparin (LMWH) in patients with acute ischemic stroke (AIS). Therefore this meta-analysis was carried out, aiming to systematically investigate the short-term and long-term safety and efficacy of LMWH in AIS patients. Three electronic databases-PubMed, Embase database, and Cochrane library-were comprehensively retrieved by 2 investigators independently. Finally, a total of 19 randomized controlled trials were enrolled for analysis. The safety endpoints in this study included all-cause mortality and the risk of bleeding (major, minor, or cerebral hemorrhage). The efficacy endpoints were the prevention of deep vein thrombosis (DVT) and recurrent stroke. The application of LMWH led to a decreased risk of DVT, and there was no significant association in all-cause mortality or recurrent stroke. According to age-stratified analyses, the risk of all-cause mortality increased by 39% (risk ratio 1.39, 1.03-1.88; I2 0%) in AIS patients aged older than 70 years who used LMWH for 14 days, and there was no significant effect on preventing DVT (risk ratio 0.69, 0.14-3.52; I2 26.4%) in patients aged younger than 70 years old within 3 months. Moreover, enoxaparin and danaparoid were more effective at preventing DVT, regardless of age. To sum up, on the basis of limited studies available currently, the early use of LMWH in AIS patients aged older than 70 years should be cautious because it may increase the risk of all-cause mortality. For patients younger than 70 years old, the early use of LMWH significantly reduces the short-term risk of DVT, but there is no significant relationship in the long term. In terms of DVT prevention, enoxaparin and danaparoid are probably more effective. Nonetheless, more future randomized controlled trials are warranted to verify and support this conclusion. Copyright © 2020 Elsevier Inc. All rights reserved.

Citation

Yi Ye, Wenqin Zhou, Wenke Cheng, Yanmin Liu, Rong Chang. Short-Term and Long-Term Safety and Efficacy of Treatment of Acute Ischemic Stroke with Low-Molecular-Weight Heparin: Meta-Analysis of 19 Randomized Controlled Trials. World neurosurgery. 2020 Sep;141:e26-e41