The Usage of Intravenous Heparin in Acute Ischemic Stroke in 10 Teaching Hospitals

J Korean Neurol Assoc > Volume 23(4); 2005 > Article

Journal of the Korean Neurological Association 2005;23(4): 446-450.

급성기 허혈성 뇌졸중에서 10개 교육병원의 정맥주사 헤파린 이용 실태

윤성상, 허성혁 박기정 장혜정a 안태범 장대일 정경천 권영대b

경희대학교 의과대학 신경과학교실, 경희대학교 경영대학 의료경영학과a, 성균관대학교 의과대학 사회의학교실b

The Usage of Intravenous Heparin in Acute Ischemic Stroke in 10 Teaching Hospitals

Sung Sang Yoon

Department of Neurology, KyungHee University College of Medicine, Seoul; Department of Health Services Management, KyungHee University College of Business Administrationa, Seoul; Department of Social & Preventive Medicine, Sungkyunkwan University College of Medicineb, Seoul, Korea

Abstract

Background: Treatment with heparin has been an area of great controversy among neurologists. The goal of this study was to compare the actual usage patterns of intravenous heparin according to the stroke subtype, location, severity of the stroke, different hospitals, and various departments.
Methods: The records of 1204 patients with acute ischemic stroke admitted to 10 teaching hospitals between January 2000 and December 2000 were reviewed. The patients were divided into two groups of whether or not they were given intravenous heparin. Cases of acute ischemic stroke were subdivided according to the TOAST classification. Patients with NIH Stroke Scale scores were categorized as having mild, moderate, and severe stroke. Terminal hospital stays were subdivided further by department: internal medicine, neurology, neurosurgery, rehabilitation medicine, and others.
Results: 512 patients (42.5%) were treated with heparin. The usage of heparin in the case of large artery atherosclerosis occupied 46%, small vessel occlusion 31 percent, cardioembolism 73%, other determined etiology 33%, and undetermined etiology 46%. Heparin was used to treat 46% of the patients with a lesion of anterior circulation, 49% of posterior circulation, and 38% of both anterior and posterior circulation. Heparin was more frequently used for moderate and severe strokes compared to mild strokes.
Conclusions: The utilization of intravenous heparin was more frequent in treatment of the cardioembolism subtype and moderate-to-severe strokes. Practice variation according to the hospitals and discharge departments were manifested.KeyWords:Cerebral infarctions, Heparin sodium