Results
Title

Delayed Occlusion after Internal Carotid Artery Dissection under Heparin.

Authors

J.P. Dreier; F. Lürtzing; M. Kappmeier; G. Bohner; R. Klingebiel; S. Leistner; K.M. Einhäupl; E. Schielke; J.M. Valdueza

Abstract

Internal carotid artery dissection (ICAD) is a frequent etiology of stroke in the young. Immediate anticoagulation with unfractionated heparin is the most frequent treatment. A theoretical side effect of unfractionated heparin is an increase in the intramural hematoma resulting in hemodynamic cerebral infarction. We studied 20 patients with ICAD. All patients were immediately treated with unfractionated heparin. Activated partial thromboplastin time (aPTT) ratios were measured twice daily. We prospectively monitored the course of ICAD with repeated ultrasound in hospital. Unexpectedly, delayed ICA occlusion was noted in 5 patients under treatment. One of these developed a watershed infarct. We then analyzed the aPTT ratios over the first 6 days after diagnosis. Patients with delayed occlusion had significantly higher aPTT ratios (2.6 ± 0.4 vs. 2.0 ± 0.5, p < 0.05). Within the limits of a partially retrospective design, our study seems to support the notion that unfractionated heparin can increase the intramural hematoma. Our findings further justify a randomized clinical trial to resolve the anticoagulant/antiplatelet debate.Copyright © 2004 S. Karger AG, Basel

Subjects

CAROTID artery; ETIOLOGY of diseases; HEPARIN; ANTICOAGULANTS; CEREBRAL infarction

Publication

Cerebrovascular Diseases, 2004, Vol 18, Issue 4, p296

ISSN

1015-9770

Publication type

Academic Journal

DOI

10.1159/000080355