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Title: Low-Molecular-Weight Heparin Superior to Unfractionated Heparin in Preventing Deep Vein Thrombosis in Stroke Patients: Presented at ISC

"Low-Molecular-Weight Heparin Superior to Unfractionated Heparin in Preventing Deep Vein Thrombosis in Stroke Patients: Presented at ISC"

By Ed Susman SAN FRANCISCO, CA -- February 12, 2007 -- The low-molecular-weight heparin enoxaparin (Lovenox) proved superior to unfractionated heparin in preventing deep vein thrombosis among patients who were paralyzed due to ischemic strokes, researchers said here at the 2007 International Stroke Conference (ISC). "This trial suggests that enoxaparin could become the preferred treatment to prevent deep vein clots in stroke patients," said David Sherman, MD, professor of neurology, University of Texas Health Science Center, San Antonio, Texas. In the trial, 878 patients were treated with the unfractionated heparin and 884 patients were assigned to receive enoxaparin in the prospective, randomized, open-label study, sponsored by sanofi-aventis, the Paris-based pharmaceutical company that markets Lovenox. Deep vein thrombosis was experienced by 18% of patients on unfractionated heparin compared to 10% of patients taking enoxaparin, researchers said in a late-breaker oral presentation on February 9[^th.

The 56% reduction in deep vein thrombosis was highly significant (P = .0008), Dr. Sherman said.

"If patients receive no treatment for deep vein thrombosis, clots occur in about 50% of the cases," Dr. Sherman said at a press briefing.

Patients were recruited into the Prevention of Venous Thromboembolism after Acute Ischemic Stroke with LMWH Enoxaparin (PREVAIL) trial within 48 hours of having an acute ischemic stroke that was verified through computer-assisted tomography or magnetic resonance imaging techniques. They were then assigned at random to receive either enoxaparin or unfractionated heparin. Patients received the drugs for about 10 days.

"We are conducting pharmacoeconomic studies to determine if the use of enoxaparin is cost effective," Dr. Sherman said. Those studies will be presented at future medical meetings, he said.

"The efficacy data in this study is solid and positive," commented Philip Gorelick, professor and chairman, department of neurology, University of Illinois, Chicago, Illinois. "But we also have to consider costs. There is a dramatic cost differential between unfractionated heparin and enoxaparin."

The conference was sponsored by the American Stroke Association, a division of the American Heart Association.

[Presentation title: Venous Thromboembolism Prophylaxis with Enoxaparin versus Unfractionated Heparin and Timing of Initiation in Acute Ischemic Stroke Patients. Abstract LB1]

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