Failure of Heparin to Prevent Progression in Progressing Ischemic Infarction

Anticoagulation with heparin is frequently recommended for patients with progressing ischemic cerebral infarction, yet little data is available detailing the acute results of treatment with this agent. We report the results of continuous intravenous heparin treatment in 36 consecutive patients admitted with progressing ischemic infarction, all of whom had computed tomography scans to exclude the diagnosis of hemorrhage prior to treatment. Overall, 18 of 36 (50%) had continued neurologic worsening despite treatment. The incidence of further worsening was greater in carotid territory infarctions (14 of 19, 74%) than in either vertebrobasilar (2 of 8, 25%) or lacunar (2 of 9, 22%) infarctions (p<0.05, Fisher's exact test). These observations suggest that additional controlled studies of the efficacy of heparin in progressing ischemic infarction are warranted. (Stroke 1988; 19:10-14) A lthough the use of anticoagulants in the treat-/ \ ment of ischemic cerebrovascular disease A. \- continues to be controversial, many experts believe that one circumstance in which anticoagulants are most likely to be of benefit is in progressing ische-mic infarction or "stroke-in-evolution."'~3 The mos