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Title: Low-Molecular-Weight Heparin More Effective in Ischemic Stroke With Large Artery Disease: Presented at ISC

"Low-Molecular-Weight Heparin More Effective in Ischemic Stroke With Large Artery Disease: Presented at ISC"

By Paula Moyer KISSIMMEE, FL -- February 22, 2006 -- The effects of low-molecular-weight heparin (LMWH) in acute ischemic stroke differ depending on whether or not the patient has large artery disease, researchers reported in a here at the annual meeting of the International Stroke Conference (ISC). "For patients with large artery disease, low-molecular-weight heparin … showed benefit in terms of disability measured by the Modified Rankin score and also in cognitive function," said principal investigator Lawrence K. S. Wong, MD, on February 17[^th. "In contrast, heparin appeared hazardous when compared with aspirin among the patients without large artery disease."

"Our study underscores the importance of brain and artery imaging to determine the subtype of stroke," added Dr. Wong, who is Professor and Chief of Neurology, Chinese University of Hong Kong, Shati, Hong Kong.

For this trial, the Fraxiparin in Stroke Study for the treatment of ischemic stroke (FISS-tris), Dr. Wong and co-investigators recruited 599 acute stroke patients, 353 of whom had large artery disease and 246 in whom large arteries were not involved. The data for 241 of the latter group were included in the analysis.

The aspirin group consisted of 294 patients, 173 of whom had large artery disease and 119 of whom did not. The LMWH group consisted of 305 patients, 180 of whom had large artery disease and 125 of whom did not.

Large artery involvement or its absence was confirmed by Doppler ultrasound. The investigators randomized patients to receive either LMWH or aspirin. The LMWH product used consisted of nadroparin (Fraxiparin) given at a dose of 3,800 IU/0.4 mL twice daily for 10 days. Aspirin was given at a dose of 160 mg given once daily, also for 10 days. All patients received 80 to 325 mg daily for 6 months subsequently.

A positive outcome defined as a modified Rankin score of 0 to 1 at 6 months.

Primary outcomes for patients with large artery disease did not differ significant by treatment group when assessed by Bartel Index, with 73% of such patients in the nadroparin arm and 69% of those in the aspirin group having a positive outcome as defined by a Bartel Index score of at least 85 at 6 months after the stroke.

However, the assessment by modified Rankin score showed that 54% of the nadroparin patients and 44% of the aspirin patients with large artery disease achieved this threshold (P < .05).

In patients without large artery disease, those on aspirin had better outcomes, with an odds ratio of 5 compared to such patients on nadroparin for a positive outcome as defined by the Bartel index and the modified Rankin score.

On the basis of these findings, the investigators suggested that stroke patients without large artery disease should be treated with aspirin. Nadroparin should be studied further as a treatment for ischemic stroke patients with large artery disease, they added.

Fraxiparin is manufactured by Sanofi, which donated the product for the study.

[Presentation title: Different Effects of Low-Molecular-Weigh Heparin on acute Stroke patients with or without Large-Artery Occlusive Disease. Abstract LB5]

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