PLACE OF ANTICOAGULANTS IN TREATMENT AND PREVENTION OF ISCHEMIC STROKE (review of evidence base of use)
DOI:
https://doi.org/10.11603/2312-0967.2019.2.10196Keywords:
ischemic stroke, anticoagulants, evidence-based medicineAbstract
The aim of the work. Dissemination and systematization of Cochrane and systematic reviews as well as meta-analyses in terms of the use of anticoagulants for ischemic stroke with a focus on new evidence-based medicine.
Materials and Methods. The materials for the study included publications (Cochrane and systematic reviews and meta-analyses) in DORIS and Medline databases on the use of anticoagulants for ischemic stroke. The extended search of the aforementioned databases was performed in March 2019. The study includes 6 Cochrane reviews, 8 systematic reviews and 4 meta-analyses (full text reviews or abstracts). Methods used: information search, analysis, synthesis and generalization. The systematization of data was performed according to the type of antithrombotic agent, its dosage, etc.
Results and Discussion. Data on efficacy and safety of the use of parenteral anticoagulants (unfractionated heparin (UFH), low molecular weight heparin (LMWH), heparinoids) and oral anticoagulants (vitamin K antagonists, thrombin inhibitors or blood coagulation factor Xa) in the acute period of ischemic stroke and its secondary prevention have been analyzed and systematized. In acute ischemic stroke, anticoagulants do not have any benefits over antiplatelet therapy in reducing mortality and dependence; anticoagulant therapy does not reduce mortality from all causes; it slightly reduces the frequency of repeated ischemic strokes, as well as further decreases pulmonary embolism and deep vein thrombosis. In the latter case, LMWH or heparinoids exceed UFH. Anticoagulant therapy in acute ischemic stroke increased the number of intracranial (IHC), extracranial or intracerebral (ICH) hemorrhages. Higher doses of anticoagulants increase the risk of ICH or IHC and do not improve the overall outcome of treatment for patients with acute ischemic stroke. No benefit from long-acting anticoagulant therapy for the secondary prevention of non-cardioembolic ischemic stroke or transient ischemic attack was found.
Conclusions. The development of research in the field of anticoagulant therapy in ischemic stroke, the evolution of views on the role of anticoagulants in the treatment and prevention of this pathology indicate that the study of the efficacy and safety of this group of drugs in modern stroke research has been and remains an important trend. Given the replenishment of the evidence base with the results of new clinical studies that have already been reflected in the recommendations of the American Heart Association and the American Stroke Association, it is advisable to revise and supplement the domestic medical and technological documents that regulate clinical aspects of the provision of medical care in ischemic stroke.
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