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Discarding Heparins as Treatment for Progressive Stroke in Sweden 2001 to 2008

Eriksson, Marie; Stecksen, Anna; Glader, Eva-Lotta; Norrving, Bo LU ; Appelros, Peter; Asberg, Kerstin Hulter; Stegmayr, Birgitta; Terent, Andreas and Asplund, Kjell (2010) In Stroke: a journal of cerebral circulation 41(11). p.2552-2558
Abstract
Background and Purpose-High-dose heparin has been used extensively to treat patients with progressive ischemic stroke, but the scientific support is poor and the current stroke guidelines advise against its use. We studied how heparin treatment for progressive stroke has been discarded in Sweden. Methods-All 78 hospitals in Sweden that admit acute stroke patients participate in Riks-Stroke, the Swedish Stroke Register. During 2001 to 2008, information on the use of high-dose heparin was available for 155 344 patients with acute ischemic stroke. The determinants as to region, patient characteristics, and stroke service settings were analyzed. Results-Use of heparin for progressive stroke declined from 7.5% (2001) to 1.6% (2008) of all... (More)
Background and Purpose-High-dose heparin has been used extensively to treat patients with progressive ischemic stroke, but the scientific support is poor and the current stroke guidelines advise against its use. We studied how heparin treatment for progressive stroke has been discarded in Sweden. Methods-All 78 hospitals in Sweden that admit acute stroke patients participate in Riks-Stroke, the Swedish Stroke Register. During 2001 to 2008, information on the use of high-dose heparin was available for 155 344 patients with acute ischemic stroke. The determinants as to region, patient characteristics, and stroke service settings were analyzed. Results-Use of heparin for progressive stroke declined from 7.5% (2001) to 1.6% (2008) of all patients with ischemic stroke. The marked regional differences present in 2001 were reduced over time. The use of heparin declined at a similar rate in all types of hospital settings, in stroke units vs nonstroke units, and in neurological vs medical wards. Independent predictors of use of heparin included younger age, first-ever stroke, independence in activities of daily living before stroke, atrial fibrillation, no aspirin treatment, and lowered consciousness on admission. Conclusions-There is no immediate, stepwise effect of new scientific information and national guidelines on clinical practice. Rather, the phasing out of heparin has followed a linear course over several years, with less variation between hospitals. We speculate that open comparisons between hospitals in a national stroke register may have helped to reduce the variations in clinical practice. (Stroke. 2010;41:2552-2558.) (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute ischemic stroke, heparin
in
Stroke: a journal of cerebral circulation
volume
41
issue
11
pages
2552 - 2558
publisher
American Heart Association
external identifiers
  • wos:000283443500038
  • scopus:78149360855
ISSN
1524-4628
DOI
10.1161/STROKEAHA.110.597724
language
English
LU publication?
yes
id
5027e8b7-2472-441d-9abf-da6301fff8b1 (old id 1720221)
date added to LUP
2010-12-03 15:22:32
date last changed
2018-05-29 10:57:22
@article{5027e8b7-2472-441d-9abf-da6301fff8b1,
  abstract     = {Background and Purpose-High-dose heparin has been used extensively to treat patients with progressive ischemic stroke, but the scientific support is poor and the current stroke guidelines advise against its use. We studied how heparin treatment for progressive stroke has been discarded in Sweden. Methods-All 78 hospitals in Sweden that admit acute stroke patients participate in Riks-Stroke, the Swedish Stroke Register. During 2001 to 2008, information on the use of high-dose heparin was available for 155 344 patients with acute ischemic stroke. The determinants as to region, patient characteristics, and stroke service settings were analyzed. Results-Use of heparin for progressive stroke declined from 7.5% (2001) to 1.6% (2008) of all patients with ischemic stroke. The marked regional differences present in 2001 were reduced over time. The use of heparin declined at a similar rate in all types of hospital settings, in stroke units vs nonstroke units, and in neurological vs medical wards. Independent predictors of use of heparin included younger age, first-ever stroke, independence in activities of daily living before stroke, atrial fibrillation, no aspirin treatment, and lowered consciousness on admission. Conclusions-There is no immediate, stepwise effect of new scientific information and national guidelines on clinical practice. Rather, the phasing out of heparin has followed a linear course over several years, with less variation between hospitals. We speculate that open comparisons between hospitals in a national stroke register may have helped to reduce the variations in clinical practice. (Stroke. 2010;41:2552-2558.)},
  author       = {Eriksson, Marie and Stecksen, Anna and Glader, Eva-Lotta and Norrving, Bo and Appelros, Peter and Asberg, Kerstin Hulter and Stegmayr, Birgitta and Terent, Andreas and Asplund, Kjell},
  issn         = {1524-4628},
  keyword      = {acute ischemic stroke,heparin},
  language     = {eng},
  number       = {11},
  pages        = {2552--2558},
  publisher    = {American Heart Association},
  series       = { Stroke: a journal of cerebral circulation},
  title        = {Discarding Heparins as Treatment for Progressive Stroke in Sweden 2001 to 2008},
  url          = {http://dx.doi.org/10.1161/STROKEAHA.110.597724},
  volume       = {41},
  year         = {2010},
}