Influence of Intravenous Heparin Therapy in Patients with Progressive Stroke and Crescendo Transient Ischemic Attacks

Introduction: Progressing stroke (PS) and Crescendo Transient Ischemic Attacks (CTIA) are generally accepted, though unproven, indications for urgent anticoagulation and there remains evidence-free practice of intravenous heparin therapy in these patients. Methods and Materials: Consecutive PS and CTIA patients admitted in Mashhad Ghaem hospital during 20072008, enrolled in a prospective observational study. PS and CTIA patients underwent intravenous heparin therapy 1000 units per hour for 3 days without bolus dose. PS and CTIA patients who had a contraindication of intravenous heparin therapy received 80 mg Aspirin per day. Early clinical courses including improvement, stabilization, deterioration and development of residual stroke were evaluated in two therapeutic groups of PS and CTIA patients.. Results: 170 PS patients (103 males, 67 females) with mean age 60.4±12.3 years and 88 CTIA patients (50 males, 38 females) with mean age 60.1± 6.8 years were investigated. 141 PS and 64 CTIA patients received a short period of intravenous heparinization. The distribution of subtypes of early clinical course into two therapeutic groups of PS and CTIA patients was significantly different; X=10.487, df=2 , p=0.005 and X=6.72, df=2 , p=0.035 respectively. Distribution of residual stroke in two therapeutic groups of PS and CTIA patients was not significantly different; X=1.443, df=1, p=0.23, OR=0.557 (0.212-1.462) and X=1.01, df=1, p=0.315, OR=0.617 (0.24-1.587) respectively. Conclusion: PS and CTIA patients who received a short period of intravenous heparin therapy have significantly more probability of improvement and less probability of deterioration in their early clinical course.