Abstract W P312: Secular Trends of Intravenous Heparin Use for Acute Ischemic Stroke in Korea: From 2008 To 2013

Abstract

Background: Since the introduction of intravenous (IV) heparin for the treatment of acute ischemic stroke in 1941, its use has been an area of great controversy among neurologists. Current American Heart Association guideline does not recommend IV heparin for the treatment of acute ischemic stroke. We sought to obtain updated information regarding the practices of Korean neurologists with regard to acute heparin use. Methods: Based on a prospective multicenter stroke registry database (CRCS-5), we collected patients with acute ischemic stroke, arrived within 7 days of symptom onset, from 2008 to 2013. Patient’s demographics, medical history and stroke characteristics were compared between IV heparin user and non-user. Results: Total of 23,425 patients from 12 regional stroke centers or university hospitals across the nation was analyzed. The mean age was 67.8 years and 58.1% was male. Median initial NIHSS score was 4 (interquartile range, 2 - 9). Large artery atherosclerosis was the most common cause of acute ischemic stroke (37.1%), followed by cardioembolism (21.9%), and small-vessel occlusion (18.9%). During the study period, use of IV heparin decreased; 9.7% in 2008; 10.9% in 2009; 9.4% in 2010; 6.0% in 2011; 4.7% in 2012; 4.3% in 2013 (p for trend < 0.001). The most prominent reduction was observed between 2010 and 2011, just after the first release of the Korean Stroke Guidelines in October, 2009. Cardioembolism (17.1%) and stroke of two or more causes (15.3%) were associated with IV heparin, and the decrease of IV heparin use in these stroke subtypes was a major contributor of the decrease in general. Age (age ≥ 75, 7.5%; age <75, 6.6%; p = 0.014), initial stroke severity (NIHSS < 5, 5.4%; NIHSS 5 - 24, 8.7%; NIHSS ≥ 25, 9.5%; p < 0.001), and atrial fibrillation on electrocardiogram (atrial fibrillation, 19.9%; non-atrial fibrillation, 4.2%; p < 0.001) were also associated with IV heparin. Conclusions: Use of IV heparin for patients with acute ischemic stroke is decreasing in Korea, and this change may be explained by the development and spread of the national stroke guidelines in the Korean language.