Trials Comparing Heparin to Aspirin in Acute Stroke

The Heparin in Acute Embolic Stroke Trial (HAEST) was a multicenter, randomized trial of the effect of LMWH (dalteparin 100 IU/kg sc twice daily) or aspirin (160 mg once daily) for the acute treatment of 449 patients with ischemic stroke and atrial fibrillation (AF).13 The primary outcome was the rate of recurrent stroke within 14 days. No difference in rates of early recurrence (8.5% dalteparin treated vs. 7.5% aspirin treated) or good 3-month functional outcome was found. The frequency of early sICH was 2.7% on dalteparin versus 1.8% on aspirin.

Tinzaparin in Acute Ischemic Stroke Trial (TAIST) was a randomized, doubleblind trial that compared high-dose tinzaparin (175 IU/kg/day), medium-dose tinza-parin (100 IU/kg/day), or aspirin (300mg/day) started within 48 hours of acute ischemic stroke, given for up to 10 days.14 The proportion of patients independent at 6 months was similar in all the three groups (41.5% high-dose tinzaparin, 42.5% medium-dose tinzaparin, 42.5% aspirin). Rates of disability, case fatality, and neurological deterioration were also similar. No patients in the high-dose tinzaparin group developed a symptomatic DVT, but nine occurred in the aspirin group. A dose-dependent incidence of sICH was observed (seven with high-dose tinzaparin, three in the medium-dose tinzaparin group, and one in the aspirin group). Neither subtype-specific benefit of tinzaparin, nor a benefit on analysis of subgroups defined by age, gender, severity, or time to treatment onset was observed.

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