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document
Low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation : a double-blind randomised study . HAEST Study Group . Heparin in Acute Embolic Stroke Trial . BACKGROUND Patients with acute ischaemic stroke and atrial fibrillation have an increased risk of early stroke recurrence , and anticoagulant treatment with heparins has been widely advocated , despite missing data on the balance of risk and benefit . METHODS Heparin in Acute Embolic Stroke Trial ( HAEST ) was a multicentre , randomised , double-blind , and double-dummy trial on the effect of low-molecular-weight heparin ( LMWH , dalteparin 100 IU/kg subcutaneously twice a day ) or aspirin ( 160 mg every day ) for the treatment of 449 patients with acute ischaemic stroke and atrial fibrillation . The primary aim was to test whether treatment with LMWH , started within 30 h of stroke onset , is superior to aspirin for the prevention of recurrent stroke during the first 14 days . FINDINGS The frequency of recurrent ischaemic stroke during the first 14 days was 19/244 ( 8.5 % ) in dalteparin-allocated patients versus 17/225 ( 7.5 % ) in aspirin-allocated patients ( odds ratio=1.13 , 95 % CI 0.57-2.24 ) . The secondary events during the first 14 days also revealed no benefit of dalteparin compared with aspirin : symptomatic cerebral haemorrhage 6/224 versus 4/225 ; symptomatic and asymptomatic cerebral haemorrhage 26/224 versus 32/225 ; progression of symptoms within the first 48 hours 24/224 versus 17/225 ; and death 21/224 versus 16/225 . There were no significant differences in functional outcome or death at 14 days or 3 months . INTERPRETATION The present data do not provide any evidence that LMWH is superior to aspirin for the treatment of acute ischaemic stroke in patients with atrial fibrillation . However , the study could not exclude the possibility of smaller , but still worthwhile , effects of either of the trial drugs .
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Intervention_Pharmacological
Low molecular-weight heparin
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Intervention_Pharmacological
aspirin
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Intervention_Pharmacological
heparins
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Intervention_Pharmacological
Heparin
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Intervention_Pharmacological
low-molecular-weight heparin ( LMWH
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Intervention_Pharmacological
dalteparin
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Intervention_Pharmacological
aspirin
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Intervention_Pharmacological
LMWH
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Intervention_Pharmacological
aspirin
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Intervention_Pharmacological
dalteparin
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Intervention_Pharmacological
aspirin :
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Intervention_Pharmacological
LMWH
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Outcome_Mortality
early stroke recurrence
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Outcome_Physical
recurrent stroke
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Outcome_Mental
frequency of recurrent ischaemic stroke
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Outcome_Other
symptomatic cerebral haemorrhage
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Outcome_Mental
symptomatic and asymptomatic cerebral haemorrhage
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Outcome_Physical
progression of symptoms within the first 48 hours
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Outcome_Physical
functional outcome or death
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Participant_Condition
acute ischaemic stroke
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Participant_Condition
atrial fibrillation
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Participant_Condition
acute ischaemic stroke
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Participant_Condition
atrial fibrillation
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Participant_Sample-size
449
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Participant_Condition
acute ischaemic stroke and atrial fibrillation