Simple and safe heparin regimen for acute ischaemia

Bittencourt, P. R. M.; Padilha, S.; Mazer, S.

doi:10.1590/S0004-282X1986000100003

Abstracts

The risk/benefit ratio of acute anticoagulation in ischaemic cerebro-vascular disease is not clearly established. A simple and safe intermittent intravenous heparin regimen (20000 IU daily) was used prospectively in 50 patients of 57 ± 14 (m ± sd) years of age whose blood pressures ranged from normal to severe hypertension. Twenty-two patients had cardiogenic embolism and the remaining had recurrent severe transient ischaemic attacks of recent onset or progressive cerebral infarcts. Time of exposure to heparin was 6.4 ± 4 (m±sd) days. Two patients had recurrences of cerebral thromboembolism and none had bleeding complications. This is a safe and efficient method of anticoagulation for patients with cerebral ischaemia when continuous infusion of heparin or close monitoring of clotting times are not used routinely.

A relação entre risco e benefício de anticoagulação imediata em doença cerebrovascular isquêmica é discutível. Um regime simples e seguro de administração endovenosa de heparina (20000 IU/dia) foi utilizado prospectivamente em 50 pacientes de 57 ± 14 (média ± desvio padrão) anos de idade cujas pressões arteriais variaram de normais a hipertensão severa. Vinte e dois dos pacientes sofreram embolia cerebral cardiogênica e o restante ataques isquêmicos transitórios de início recente ou infartos cerebrais progressivos. O tempo de exposição à heparina foi de 6,4 ± 4 (média ± desvio padrão) dias. Dois pacientes tiveram recorrência de tromboembolismo cerebral e nenhum teve complicações hemorrágicas. Este parece ser um método seguro e eficiente de anticoagulação para pacientes com isquemia cerebral aguda, quando infusão contínua de heparina ou monitorização de testes de coagulação frequente não são usados rotineiramente.

P. R. M. Bittencourt^I; S. Padilha^I; S. Mazer^II

^IUnidade de Neurologia Clínica - Hospital Nossa Senhora das Graças Curitiba

^IIUnidade de Tomografia Axial Computadorizada - Hospital Nossa Senhora das Graças Curitiba

SUMMARY

The risk/benefit ratio of acute anticoagulation in ischaemic cerebro-vascular disease is not clearly established. A simple and safe intermittent intravenous heparin regimen (20000 IU daily) was used prospectively in 50 patients of 57 ± 14 (m ± sd) years of age whose blood pressures ranged from normal to severe hypertension. Twenty-two patients had cardiogenic embolism and the remaining had recurrent severe transient ischaemic attacks of recent onset or progressive cerebral infarcts. Time of exposure to heparin was 6.4 ± 4 (m±sd) days. Two patients had recurrences of cerebral thromboembolism and none had bleeding complications. This is a safe and efficient method of anticoagulation for patients with cerebral ischaemia when continuous infusion of heparin or close monitoring of clotting times are not used routinely.

RESUMO

A relação entre risco e benefício de anticoagulação imediata em doença cerebrovascular isquêmica é discutível. Um regime simples e seguro de administração endovenosa de heparina (20000 IU/dia) foi utilizado prospectivamente em 50 pacientes de 57 ± 14 (média ± desvio padrão) anos de idade cujas pressões arteriais variaram de normais a hipertensão severa. Vinte e dois dos pacientes sofreram embolia cerebral cardiogênica e o restante ataques isquêmicos transitórios de início recente ou infartos cerebrais progressivos. O tempo de exposição à heparina foi de 6,4 ± 4 (média ± desvio padrão) dias. Dois pacientes tiveram recorrência de tromboembolismo cerebral e nenhum teve complicações hemorrágicas. Este parece ser um método seguro e eficiente de anticoagulação para pacientes com isquemia cerebral aguda, quando infusão contínua de heparina ou monitorização de testes de coagulação frequente não são usados rotineiramente.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Unidade de Neurologia Clínica, Hospital Nossa Senhora das Graças - Rua Alcides Munhoz, 433 - 80.000 - Curitiba, PR - Brasil.

1. BITTENCOURT, P.R.M.; GIAMBERARDINO, E.; PRECOMA, D. & MAZER, S. - Fisiopatologia de doenças cerebro-vasculares isquêmicas. Rev. neurol. Argent. 9:95, 1983.
2. DEYKIN, D. - Heparin therapy: regimens and management. Drugs 13:46, 1977.
3. DRAKE, M.E. & SHIN, C. - Conversion of ischaemic to haemorrhagic infarction by anticoagulant administration. Arch. Neurol. 40:44, 1983.
4. EASTON, J.D. & SHERMAN, D.G. - Management of cerebral embolism of cardiac origin. Stroke 11:433, 1980.
5. PIEIiDS, W.S. - Aspirin for prevention of stroke. J. Med. 14:61, 1983.
6. FURLAN, A.J.; CAVALIER, S.J.; HOBBS, R.E.; WEINSTEIN, M.A. & MODIC, M.T. - Haemorrhage and anticoagulation after nonseptic embolic brain infarction. Neurology 32:280, 1982.
7. GENTON, E. - Guidelines for heparin therapy. Ann. int. Med. 80:77, 1984.
8. GENTON, E.; BARNETT, H.J.M.; FIELDS, W.S.; GENT, M. & HOAK, J.C. - Cerebral ischaemia: the role of thrombosis of antithrombotic therapy. Stroke 8:150, 1977.
9. LODDER, J. & van der LUGT, P.J.M. - Evaluation of the risk of immediate anticoagulant treatment in patients with embolic stroke of cardiac origin. Stroke 14:42, 1983.
10. MARSHALL, J. - The cause and prognosis of strokes in people under 50 years. J. neurol. Sci. 53:473, 1982.
11. MILLIKAN, C. - Anticoagulant treatment to prevent cerebral infarction. Med. clin. North America 63:897, 1979.
12. RUFF, R.L. & DOUGHERTY, J.H. - The evaluation of acute cerebral ischaemia for anti-coagulant therapy: computed tomography or lumbar puncture. Neurology 31:736, 1981.
13. SALZMAN, E.W.; DBYKIN, D.; SHAPIRO, R.M. & ROSEMBERG, R. - New Engl. J. Med. 292:1046, 1975.
14. SILVERSTEIN, A. - Neurological complications of anticoagulation therapy. Arch, int. Med. 139:217, 1979.

Simple and safe heparin regimen for acute ischaemia

Regime simples e seguro de heparina para isquemia aguda

Publication Dates

Publication in this collection
29 June 2011
Date of issue
Mar 1986

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BITTENCOURT, P.R.M.; GIAMBERARDINO, E.; PRECOMA, D. & MAZER, S. - Fisiopatologia de doenças cerebro-vasculares isquêmicas. Rev. neurol. Argent. 9:95, 1983.

[2] 2. DEYKIN, D. - Heparin therapy: regimens and management. Drugs 13:46, 1977.

[3] 3. DRAKE, M.E. & SHIN, C. - Conversion of ischaemic to haemorrhagic infarction by anticoagulant administration. Arch. Neurol. 40:44, 1983.

[4] 4. EASTON, J.D. & SHERMAN, D.G. - Management of cerebral embolism of cardiac origin. Stroke 11:433, 1980.

[5] 5. PIEIiDS, W.S. - Aspirin for prevention of stroke. J. Med. 14:61, 1983.

[6] 6. FURLAN, A.J.; CAVALIER, S.J.; HOBBS, R.E.; WEINSTEIN, M.A. & MODIC, M.T. - Haemorrhage and anticoagulation after nonseptic embolic brain infarction. Neurology 32:280, 1982.

[7] 7. GENTON, E. - Guidelines for heparin therapy. Ann. int. Med. 80:77, 1984.

[8] 8. GENTON, E.; BARNETT, H.J.M.; FIELDS, W.S.; GENT, M. & HOAK, J.C. - Cerebral ischaemia: the role of thrombosis of antithrombotic therapy. Stroke 8:150, 1977.

[9] 9. LODDER, J. & van der LUGT, P.J.M. - Evaluation of the risk of immediate anticoagulant treatment in patients with embolic stroke of cardiac origin. Stroke 14:42, 1983.

[10] 10. MARSHALL, J. - The cause and prognosis of strokes in people under 50 years. J. neurol. Sci. 53:473, 1982.

[11] 11. MILLIKAN, C. - Anticoagulant treatment to prevent cerebral infarction. Med. clin. North America 63:897, 1979.

[12] 12. RUFF, R.L. & DOUGHERTY, J.H. - The evaluation of acute cerebral ischaemia for anti-coagulant therapy: computed tomography or lumbar puncture. Neurology 31:736, 1981.

[13] 13. SALZMAN, E.W.; DBYKIN, D.; SHAPIRO, R.M. & ROSEMBERG, R. - New Engl. J. Med. 292:1046, 1975.

[14] 14. SILVERSTEIN, A. - Neurological complications of anticoagulation therapy. Arch, int. Med. 139:217, 1979.