Low-Molecular Weight Heparin for Thromboprophylaxis after Ischaemic Stroke

Patients in the acute phase after ischaemic insult have an increased incidence of venous thrombosis in the leg and pulmonary embolism which delay recovery and contribute to a higher morbidity and mortality for these patients. Pulmonary embolism is an important cause of death in patients after ischaemic stroke. Although platelet inhibition with, e. g., acetylsalicylic acid (ASA), constitutes the standard therapy for prophylaxis against early recurrence in stroke patients, the duration and doses as well as the substances (unfractionated versus low molecular heparin), but not the necessity for anticoagulation as prophylaxis against thromboemolism, are currently a subject of controversy. Placebo- or ASA-controlled studies with heparins, mainly in PTT-effective doses, were often not clinically unambiguous in practice and showed a reduction of early reinfarctions at the cost of cerebral haemorrhage. However, all studies with low or high doses of heparin showed a reduced risk for deep vein thrombosis of the legs. New comparative studies of low-molecular heparins (Enoxaparin, Certoparin) with unfractionated have shown in recent years the significance of early anticoagulation within the first 48 hours after the insult. Their use is associated with a reduction of thromboembolic events with a concomitant unchanged risk of haemorrhage in comparison with unfractionated heparin. Furthermore, the administration of low-molecular heparins with their simple use constitutes a practical and easily applicable therapeutic principle. It can be recommended as a prophylaxis against thromboembolic complications in these patients.