Has the treatment with heparin better chance of recovery among pacients with stroke [604675]

P: stroke
I: heparin
C: no heparin
O: recovery

Has the treatment with heparin better chance of recovery among pacients with stroke?
Exact ca în schema PICO de mai sus am introdus datele pe trip database. Am avut 20 rezultate, iar eu
am ales studiul următor:
https://www.ncbi.nlm.nih.gov/pubmed/30379743
Concluzii le studiului : There are limited reports of protamine reversal of heparin before IV -tPA
administr ation. To our knowledge, there are only 6 AIS cases including ours. Three cases received
0.6 mg/kg of tPA dose. All have favorable outcomes and no intracranial hemorrhage was reported.
Protamine reversal of heparin for AIS after CC seems to be safe. Furthe r studies are needed to
confirm the therapeutic safety and efficacy of this strategy.

Pentru review am ales:
1. Diagnosis and management of Heparin induced
thrombocytopenia: second edition

2. Guidelines for the Prevention of Stroke in Women: A
Statement for Healthcare Professionals From the American
Heart Associat ion/American Stroke Association

3. Guidelines for the Prevention of Stroke in Patients With Stroke
and Transient Ischemic Attack

4. An Updated Definition of Stroke for the 21st Century: A
Statement for Healthcare professionals from the American
Heart Association/American Stroke Association

5. Scientific Rationale for the Inclusion and Exclusion Criteria
for Intravenous Alteplase in Acute Ischemic Stroke

A search was performed of PubMed and Embase using the term ‘heparin
induced thrombocytopenia’ combined with ‘diagnosis’, ‘treatment’ and
‘clinical presentation’. The search covered articles published from
January 2006 to April 2012. References in recent re views were also
examined. The writing group produced the draft guideline, which was
subsequently revised by consensus by members of the Haemostasis and
Thrombosis Task Force of the BCSH. The guideline was then reviewed
by a sounding board of approximately 50 UK Haematologists, the BCSH,
and the British Society for Haematology Committee and comments
incorporated where appropriate.
The American Heart Association makes every effort to avoid any actual
or potential conflicts of interest that may arise as a result of an outside
relationship or a personal, professional, or business interest of a member
of the writing panel. Specifically, all members of the writing group are
required to complete and submit a Disclosure Questionnaire showing all
such relationshi ps that might be perceived as real or potential conflicts of
interest.
The aim of this updated guideline is to provide comprehensive and timely
evidence -based recommendations on the prevention of future stroke
among survivors of ischemic stroke or transien t ischemic attack. The
guideline is addressed to all clinicians who manage secondary
prevention for these patients. Evidence -based recommendations are
provided for control of risk factors, intervention for vascular obstruction,
antithrombotic therapy for c ardioembolism, and antiplatelet therapy for
noncardioembolic stroke. Recommendations are also provided for the
prevention of recurrent stroke in a variety of specific circumstances,
including aortic arch atherosclerosis, arterial dissection, patent foramen
ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid
antibody syndrome, sickle cell disease, cerebral venous sinus
thrombosis, and pregnancy. Special sections address use of
antithrombotic and anticoagulation therapy after an intracranial
hemorrhage and implementation of guidelines.
Despite the global impact and advances in understanding the
pathophysiology of cerebrovascular diseases, the term “stroke” is not
consistently defined in clinical practice, in clinical research, or in

assessmen ts of the public health. The classic definition is mainly clinical
and does not account for advances in science and technology. The
Stroke Council of the American Heart Association/American Stroke
Association convened a writing group to develop an expert c onsensus
document for an updated definition of stroke for the 21st century. Central
nervous system infarction is defined as brain, spinal cord, or retinal cell
death attributable to ischemia, based on neuropathological,
neuroimaging, and/or clinical eviden ce of permanent injury. Central
nervous system infarction occurs over a clinical spectrum: Ischemic
stroke specifically refers to central nervous system infarction
accompanied by overt symptoms, while silent infarction by definition
causes no known symptom s. Stroke also broadly includes intracerebral
hemorrhage and subarachnoid hemorrhage. The updated definition of
stroke incorporates clinical and tissue criteria and can be incorporated
into practice, research, and assessments of the public health.