Anticoagulant Therapy

Trials have also been conducted to evaluate the efficacy of enoxaparin, a low-molecular-weight heparin, in the prevention of DINDs. The first trial was a double-blinded, randomized trial of 170 patients who were treated with either placebo or enoxaparin for 10 days after aneurysm occlusion. The authors found no difference in neurologic outcomes between the two groups at three months (35). A subsequent double-blinded, randomized trial was conducted in 120 consecutive patients who received a lower dose of enoxaparin for a longer period of time (three weeks); the patients were followed for one year instead of only three months (36). In the later study, enoxaparin administration was associated with a reduced rate of DINDs (8.8% vs. 66.7%; p < 0.001) and improved clinical outcomes at one-year follow-up. Unfortunately, the two groups were not precisely matched, with the placebo group having a significantly worse Hunt and Hess admission score, making it difficult to interpret the significance of these improved outcomes (as this was not controlled for in their statistical analysis). Nonetheless, with longer follow-up, lower-dose enoxaparin appears to possess some efficacy.

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