A Cochrane review [Abstract] 1 included 24 studies with a total of 23 748 subjects. They had acute presumed or confirmed ischaemic stroke without defined etiology. The anticoagulants tested were standard unfractionated heparin, low-molecular-weight heparins, heparinoids, oral anticoagulants, and thrombin inhibitors, the anticoagulant treatment was started within two weeks of stroke onset.
There was no evidence that anticoagulant therapy reduced the odds of death from all causes at the end of follow-up (OR 1.05, 95% CI 0.98 to 1.12; 11 trials, n=22 776). There was no evidence that anticoagulants reduced the odds of being dead or dependent at the end of follow-up (OR 0.99, 95% CI 0.93 to 1.04; 8 trials, n=22 125 ). A reduction in recurrent ischaemic stroke during the treatment period (OR 0.76, 95% CI 0.65 to 0.88, NNTB 108) was exactly offset by an increase in symptomatic intracranial haemorrhage (OR 2.55, 95% CI 1.95 to 3.33; NNTH 131). Similarly, anticoagulants reduced the frequency of pulmonary emboli (OR 0.60, 95% CI 0.44 to 0.81; NNTB 127), but this benefit was offset by an increase in extracranial haemorrhages (OR 2.99; 95% CI 2.24 to 3.99; NNTH 128). Sensitivity analyses did not identify a particular type of anticoagulant regimen or patient characteristic associated with net benefit.
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