Low-Molecular-Weight Heparin in Atherosclerotic Stroke

See related article, page 346.Intracranial atherosclerosis (ICAS) is a major cause of stroke worldwide, especially in Asia. In patients with symptomatic ICAS, the risk of recurrent stroke is fairly high.1 Although stenting/angioplasty is occasionally performed, a recent randomized trial failed to find the benefit of stenting in patients with symptomatic ICAS.2 Moreover, trials using antiplatelets or anticoagulants have been rare, and results are confusing. Therefore, we still do not have well-proven, effective treatment strategies for ICAS.A few retrospective nonrandomized studies have suggested that anticoagulation may be more effective than antiplatelets for secondary stroke prevention in patients with ICAS.3,4 However, Warfarin–Aspirin Symptomatic Intracranial Disease (WASID), a large randomized trial, demonstrated that warfarin was not more effective than aspirin and was associated with significantly higher bleeding risks in patients with ICAS.1 The Fraxiparin in Stroke Study for the treatment of ischemic stroke (FISS-tris) is another trial that compared nadroparin calcium, a form of low-molecular-weight heparin (LMWH), and aspirin in 353 Asian patients with symptomatic large artery occlusive disease, mostly …