NEW YORK (Reuters Health) – In terms of efficacy and safety, low-molecular weight heparin is better than unfractionated heparin in the treatment of patients presenting with cerebral venous thrombosis, an international team reports in the November issue of Stroke published online October 7.

The findings come from a non-randomized trial in which 119 patients (28%) with cerebral venous thrombosis were treated with low-molecular weight heparin (LMWH) and 302 (72%) received unfractionated heparin (UFH). As the researchers note, “There is no consensus whether to use unfractionated heparin or low-molecular weight heparin for the treatment of cerebral venous thrombosis.”

Dr. Jan Stam, at the University of Amsterdam, The Netherlands, and colleagues found that about a quarter of the patients in each group deteriorated during admission. More patients treated with UFH developed a depressed consciousness (11% versus 17%) or an altered mental state (4% versus 8%). On the other hand, new seizures were more common in LMWH-treated patients (10% versus 6%). However, none of these differences were statistically significant.

The primary end point was functional independence (i.e., a modified Rankin score of 0, 1 or 2) after 6 months. This was achieved by 92% of the LMWH group compared with 84% of those treated with UFH (odds ratio 2.1). After adjustment, the odds ratio was still 2.4 in favor of LMWH.

Furthermore, “In the multivariate analysis, there was trend toward fewer new intracranial hemorrhages among LMWH-treated patients (adjusted OR, 0.29),” according to the report.

In their discussion, the authors note that the results are in agreement with trial results in non-cerebral thromboembolism.

They conclude, “In combination with data from large randomized trials in extracerebral venous thromboembolism, a plausible pathophysiological basis, and obvious advantages of LMWH in daily practice, LMWH seems preferable over UFH for the initial treatment of patients with CVT.”

Reference:

Unfractionated or Low–Molecular Weight Heparin for the Treatment of Cerebral Venous Thrombosis

Stroke 2010; 41.