THERE ARE only 2 proved indications for intravenous heparin in acute stroke: prevention of recurrent cardiac embolism and treatment of anxiety in the administering physician. Despite the lack of firm evidence for or against its use in other circumstances, heparin is still widely administered for plausible but unproved indications, such as progression of a neurologic deficit in acute stroke.
Much of the practice stems from the belief that neurologic deterioration results from clot growth and further arterial occlusion. Although about a third of stroke patients worsen after admission to hospital, most do so from the evolution of the initial cerebral lesion. Sandercock, a leader of the International Stroke Trial, interprets its results to mean that "there really is no evidence to support the use of [intravenous] heparin in any clinical indication in acute ischemic stroke." Grau and Hacke argue that the results of the International Stroke Trial with high-dose subcutaneous heparin, without monitoring of activated partial thromboplastin time or mandatory prior computed tomographic scan, cannot be used to rule out a therapeutic effect of heparin. Although Grau and Hacke make a case for the use of short-term heparin in proved or highly probable cardiac embolism, symptomatic intracranial stenoses, deficiency of protein S, protein C, or antithrombolin III, and high-grade symptomatic internal carotid artery stenoses until surgery, they reluctantly conclude that a further randomized trial is needed. Moreover, they make the intriguing suggestion that clinicians may be able to select patients with lower risk for cerebral hemorrhage, a hypothesis that could be tested in such a clinical trial.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Neurology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Users' Guides to the Medical Literature
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.