How is low-molecular-weight heparin (LMWH) administered for the prevention of recurrent posterior cerebral artery (PCA) stroke?

Updated: Jul 30, 2018
  • Author: Erek K Helseth, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Heparin and low-molecular-weight heparin (LMWH) should be titrated individually based on aPTT. A heparin bolus is infrequently given due to concerns of hemorrhage. This approach may be justifiable given evidence that heparin does not provide an acute advantage in nonselective use in ischemic stroke.

The optimal dosing regimen for heparin in stroke has not been established. LMWHs, also known as fractionated heparins, have become available in the last few years and have revolutionized therapy of venous thrombosis and acute coronary syndromes.

LMWH therapy in the acute setting should be cautiously considered because no antidote is available for quick reversal of anticoagulation in the event of intracerebral hemorrhage. In the subacute setting, LMWH may be used as a bridge to long-term anticoagulation with warfarin.

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