Early treatment with blood‐thinning drugs for people who hav | Figure 1

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Early treatment with blood‐thinning drugs for people who have had a stroke

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Review question

We wanted to know whether people treated with anticoagulants (blood‐thinning drugs) soon after having a stroke got better or not, and whether they had problems with bleeding.

Background

Millions of people around the world have a stroke every year. Most strokes take place when a blood clot blocks a blood vessel leading to the brain. When the blood supply to the brain is restricted or blocked, brain cells begin to die. This can lead to brain injury, which can be permanent, causing disability and possibly death. Damage from a stroke can cause arm or leg weakness, or difficulties with language or vision. Strokes are sometimes fatal but more often leave survivors unable to do the things they used to do. Because strokes are common and cause such damage, researchers are looking at ways to get rid of the blood clot soon after the stroke happens. One way to do this is to use blood‐thinning drugs called anticoagulants. If patients respond well to anticoagulants, they might be able to avoid the bad effects of a stroke. The main problem with anticoagulants is that if they cause bleeding, the patient can have very serious outcomes from this.

Search date

The evidence is current to August 2021.

Study characteristics

To find the best answer, we looked for studies in which investigators compared any anticoagulant to another medicine, to a dummy medicine that does not contain any active ingredients (placebo), or to normal care. We included in this updated review 28 studies involving 24,025 people with stroke. Two studies enrolled participants within 12 hours of stroke onset, four within 24 hours, and 10 within 48 hours.

Key results

People treated with anticoagulants did not have less long‐term disability, and they experienced more bleeding. Anticoagulant‐treated patients had a lesser chance of developing blood clots in their legs and in their lungs following their stroke, but these benefits were offset by an increased number of bleeds.

Conclusion

This review did not provide any evidence to suggest that early use of anticoagulants is beneficial overall for people with stroke caused by blood clots. More research is needed to find out if there are ways to select people with stroke who will benefit most from anticoagulants without suffering the bleeding complications.

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