INFLUENCE OF SHORT TERM INTRAVENOUS ANTICOAGULATION THERAPY IN PATIENTS WITH ISCHEMIC CEREBROVASCULAR EVENTS

Abstract    BACKGROUND: Progressive stroke (PS) and Crescendo Transient Ischemic Attacks (CTIA) is a generally accepted although unproven, indication for urgent intravenous anticoagulation therapy.    METHODS: Consecutive patients with PS and CTIA admitted in Ghaem hospital, Mashhad during ۲۰۰۷ - ۲۰۰۸ enrolled in a prospective clinical study. PS and CTIA patients underwent intravenous heparin therapy with ۱۰۰۰ units per hour without a bolus dose at least for ۳ days. PS and CTIA patients who had a contraindication for intravenous hepain therapy, received ۸۰ mg Aspirin per day. Early clinical course including improvement, stabilization, deterioration and development of residual stroke was evaluated in two therapeutic groups of PS and CTIA patients.    RESULTS: ۱۷۰ PS patients (۱۰۳ males, ۶۷ females) with mean age of ۶۰.۴ ± ۱۲.۳ years and ۸۸ CTIA patients (۵۰ males, ۳۸ females) with mean age of ۶۰.۱ ± ۶.۸ years were assessed. ۱۴۱ PS and ۶۴ CTIA patients received short period intravenous heparinization. Distribution of subtypes of early clinical course between two therapeutic groups of PS and CTIA patients, was significantly different; X۲ = ۱۰.۴۸۷, df = ۲, p = ۰.۰۰۵ and X۲ = ۶.۷۲, df = ۲, p = ۰.۰۳۵ respectively. Distribution of residual stroke in two therapeutic groups of PS and CTIA patients,was not significantly different; X۲ = ۱.۴۴۳, df = ۱, p = ۰.۲۳, OR = ۰.۵۵۷ (۰.۲۱۲-۱.۴۶۲) and X۲ = ۱.۰۱, df = ۱, p = ۰.۳۱۵, OR = ۰.۶۱۷ (۰.۲۴-۱.۵۸۷) respectively.    CONCLUSION: PS and CTIA patients who underwent short period intravenous heparin therapy have significantly more probability of improvement and less probability of deterioration in their early clinical course than PS and CTIA patients who received Aspirin therapy.      Keywords: Progressive Stroke (PS) Crescendo TransientIschemic Attacks (CTIA), Intravenous anticoagulation therapy, Heparin therapy.