Anticoagulants including standard unfractionated heparin low molecular weight heparins and heparinoids

A systematic review comparing immediate anticoagulant therapy with control in acute ischaemic stroke, including over 20 000 patients, concluded that although anticoagulation started in the first day or two may reduce the risk of DVT and PE (see above), there were no short or long term benefits in terms of survival free of dependency79 (Figure 3.2). In addition, there was no evidence to support the use of anticoagulants in any specific patient category (for example, presumed cardioembolic stroke or vertebrobasilar stroke). The only situation in which we consider starting anticoagulation (with intravenous, standard unfractionated heparin) is for patients with an evolving, CT-proven ischaemic stroke which we consider is likely to be due to progressive thromboembolism, although there is no convincing evidence to justify this policy.

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