Problemas neurológicos

Addition of Low Molecular Weight Heparin to Antiplatelet in Patients with Stroke Ineligible for Thrombolysis: Can it Improve Outcome?

Abstract

Hassan Ahmed Hashem Soliman, Yasser Hamed Mustafa, Abdelhakeem Salem, Ahmed Yousry, Mohamed El-Refaey

Objective: Stroke is one of the most frequent causes of death and disability, urgent thrombolytic therapy can save thousands of lives and disabilities but unfortunately not all patients are eligible for thrombolysis. Dual antiplatelet are superior to anticoagulants in management of stroke and the use of full dose anticoagulants alone or in combination with aspirin is still debatable and carry the risk of hemorrhagic complications.

Aim of study: We aimed to compare the use double antiplatelet (oral Aspirin plus Clopidogrel) versus oral aspirin plus subcutaneous low dose enoxaparin in treatment of progressing stroke ineligible for thrombolysis.

Methods: The study was carried out on fifty-six patients presented with progressing stroke from February 2017 to the end January of 2019. Patients eligible for thrombolytic therapy (recombinant tissue plasminogen activator (r-TPA), TIA, Hemorrhagic stroke and stroke with stationary course were excluded from the study. The included patients were randomly divided into two groups, group (A) were treated with double antiplatelet aspirin 81 mg plus Clopidogrel 75 mg preceded by the loading dose of both and group (B) were treated with aspirin plus subcutaneous enoxaparin 40 mg (Clexane) once daily for 3 days. After 3 days, both groups continued on double antiplatelet aspirin 81 mg plus Clopidogrel 75 mg.

Results: We found that, at time of discharge 59.3% of group A showed progression in neurological symptoms and remaining 40.7% showed improvement in neurological symptoms while in group B only 13.8% of patients showed progression and remaining 86.2% showed improvement at this time. After one month, 55.56% of group A and 89.66% of group B of patients showed improvement and after 3 months, 66.67% of group A and 89.66% of group B showed improvement with significant difference of the outcome between both groups

Conclusion: We concluded that aspirin plus enoxaparin 40 mg could be superior to aspirin plus Clopidogrel in the early treatment of stroke.