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Massimo Camerlingo, MD; Luciano Casto, MD; Bruno Censori, MD; Bruno Ferraro, MD; GianCarlo C. Gazzaniga, MD; Bruno Cesana, MD; Angelo Mamoli, MD

Arch Neurol. 1994;51(5):462-467.

Abstract
Objective
To evaluate the safety and possible efficacy of heparin sodium anticoagulation within 5 hours of the onset of first-ever nonlacunar ischemic strokes in the internal carotid artery territories.

Design
Pilot study, prospective and open.

Setting
Inpatient stroke unit.

Patients
Of 360 stroke patients observed during 13 months, 45 (12.5%) were included in the study.

Interventions
Heparin sodium was administered intravenously, starting with a bolus of 10 000 U, followed by continuous infusion over 4 days at a rate adjusted to maintain an activated partial thromboplastin time ratio between 2 and 2.5. The mean interval from stroke to treatment was 197 minutes.

Results
Two patients had cerebral hemorrhage, one of which was fatal. None had extracranial major bleeding, while six had minor bleeding. The conditions of 23 patients improved, 16 patients were stable, and six patients worsened by day 1, while 29 patients improved, eight patients were stable, and eight patients worsened by day 7. Six patients died by the first month and five more by the sixth month. Twenty-one patients were self-sufficient, both at 1 and 6 months. Hemorrhagic complications were unrelated to any investigated factor. Multivariate analysis indicated that short-term outcome was predicted only by infarct size (P<.0001) and long-term outcome by infarct size (P=.002) and large vessel status (P=.0235).

Conclusions
Our study suggests that immediate heparin treatment for ischemic carotid stroke is feasible and generally safe and that patients whose conditions improve are those with smaller infarct size and no evidence of large vessel obstruction.

Author Affiliations
From the Second Neurological Department, Ospedali Riuniti Bergamo (Drs Camerlingo, Casto, Censori, Ferraro, Gazzaniga, and Mamoli) and Ospedale Maggiore Epidemiologic Laboratory, Istituto di Ricerca e Cura a Carattere Scientifico (Dr Cesana), Milan, Italy.

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