A controlled study on the treatment of acute progressive cerebral infarction by continuous anticoagulation with small doses of heparin

Abstract

To discuss the treatment of acute progressive cerebral infarction by continuous anticoagulation with small doses of heparin. A prospective, randomized, and controlled clinical research was conducted. Three hundred and fifty-one patients were randomly divided into three groups. Group A (n=119) was treated with heparin, which was controlled by an infusion pump with a speed of 18 U×kg(-1)×h(-1) for 24 hours, and the dosage was regulated according to the changes in activated partial thromboplastin time (APTT) which was determined every 8 hours. Group B (n=115) was treated with intravenous drip of 12,500 U of heparin with a speed of 18 U×kg(-1)×h(-1) once a day. Group C (n=117) was treated with 5000 U of low-molecular-weight heparin calcium injection twice a day. After 14 days, nerve function defect according to the National Institutes of Heath stroke scale (NIHSS) score was determined, the adverse events (e.g. intracranial hemorrhage, subcutaneous ecchymosis, gingival bleeding, hematuria and occult blood in stools) were observed. After 6 months, the recurrence rate and Barthel index (BI) would be determined. The total efficiency in group A (95.80%) was significantly higher than that in group B (85.22%) and group C (85.47%). Recurrence rate in group A (1.68%) was significantly lower than group B (8.70%) and group C (8.33%) with significant differences (P<0.05 or P<0.01), while there was no significant difference between group B and group C (both P>0.05). The BI of group A (89.27±8.56) was significantly higher than group B (72.57±9.77) and group C (71.66±9.37) with significant difference (both P<0.01), while there was no significant difference between group B and group C (P>0.05). Adverse event rate in group A (5.88%) was slightly higher than that of group B (3.48%) and group C (4.27%), but the difference was not significant (both P>0.05). Continuous infusion of low dosage of heparin could significantly reduce neurologic impairment score in patients with progressive cerebral infarction, increase cure rate, reduce the recurrence rate, and raise the BI of patients, and it dose not increase the risk of intracranial and extracranial hemorrhage.