Do We Really Need a Better Way to Give Heparin in Acute Cerebral Ischemia?

In the early 1980s, we assiduously followed management guidelines advocating intravenous heparin for patients within 2 months of transient ischemic attack (TIA) and for most patients with acute ischemic stroke. Heparin flowed freely; there were always 2 to 3 patients receiving it on the neurology ward and a dozen partial thromboplastin times were urgently checked each day. Times have changed. High standards of evidence are expected to support management recommendations, grounded firmly in randomized clinical trials rather than traditional GOBSAT methods (Good Old Boys Sat At Table).1 Nine randomized trials have tested intravenous unfractionated heparin or related agents in acute stroke.2 Critical analysis of the accumulated evidence does “not support the routine use of any type of anticoagulant in acute ischemic stroke.”2 It is clear that intravenous heparin …