Heparin or low molecular weight heparin

These do reduce the risk of DVT but:

They significantly increase the risk of important bleeding
No significant reduction in deaths
No improvement in functional outcomes
They are not recommended for routine use after stroke by Intercollegiate (NICE) OR ESO VTE guidelines for ischaemic stroke
LMWH may be used in patients at high risk of DVT AND low risk of bleeding
But unclear how these are defined

Reference:

Lederle FA, Zylla D, MacDonald R, Wilt TJ. Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med 2011;155:602-615. Link to paper.

Systematic review of RCTs of heparin in stroke patients looking at clinical outcomes

Outcome	Number of trials	Number of outcomes / number treated: Heparin	Number of outcomes / number treated: no heparin	Outcomes avoided per 1000 patients treated	95% confidence intervals
Death	8	496/5276	990/10129	-9	-29 to +18
Pulmonary emboli	5	39/5015	95/9847	-3	-5 to 0
Symptomatic DVT	1	0/101	1/105	-9	-10 to +57
Major bleeding	8	79/5276	89/10129	+6	+2 to +12

Aspirin Balancing the risks and…

Page last reviewed: 22 Apr 2020

Stroke Training and Awareness Resources (STARs)

Reference: