Enoxaparin preferable to unfractionated heparin in ischaemic stroke
Enoxaparin is more effective than unfractionated heparin at preventing venous thromboembolism (VTE) in patients with acute ischaemic stroke, according to a Lancet article published last week (2007;369:1347).
The PREVAIL study involved 1,762 patients who had had an acute ischaemic
stroke and were unable to walk unassisted. Within 48 hours of symptoms,
patients were assigned to receive either enoxaparin 40mg subcutaneously
once a day or unfractionated heparin 5,000U subcutaneously twice daily
for 10 days.
The researchers found that enoxaparin reduced the risk of VTE at day
14 by 43 per cent compared with unfractionated heparin (relative risk
0.57, 95 per cent confidence interval 0.44–0.76; P=0.0001). This
reduction was maintained at day 90 and was consistent regardless of stroke
severity.
The occurrence of any bleeding was similar in the two groups (both 8
per cent). The frequency of symptomatic intracranial haemorrhage was
also similar, although the enoxaparin group suffered a higher rate of
major extracranial bleeding (1 per cent versus 0 per cent; P=0.015).
This did not lead to increased mortality, say the researchers.
“On the basis of our data, the number needed to treat to avoid
one venous thromboembolism is 13 whereas the number needed to harm as
a result of
clinically important bleeding is 173, showing a clear net clinical benefit
in favour of enoxaparin for prophylaxis of venous thromboembolism in
patients with acute ischaemic stroke,” the researchers say.
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