Intravenous heparin for the treatment of intraluminal thrombus in patients with acute ischemic stroke: A case series

Background and Objectives Current American Stroke Association/American Heart Association recommendations on the management of acute ischemic stroke do not recommend the early use of heparin because of an increased risk of bleeding complications. However, for select patients, such as those with strokes associated with non-occlusive intraluminal thrombus, intravenous heparin might prove to be beneficial. Methods A retrospective analysis of acute ischemic stroke cases associated with non-occlusive intraluminal thrombus of intracranial and extracranial arteries in the corresponding vascular territories was conducted to identify patients in whom treatment with intravenous heparin resulted in near-complete or complete lysis of the thrombus. Imaging findings from CT perfusion and angiography, MRI, and/or digital subtraction angiography were used to describe the location of intraluminal thrombus immediately before and after treatment with intravenous heparin. Results 18 patients with nonocclusive intraluminal thrombus confirmed by CT angiography (CTA) received treatment with intravenous heparin alone (median duration 3.5 days; range 1e8 days). The median National Institutes of Health stroke scale score was 2.5 (range 0e15) on admission and 1 (range 0e9) at discharge. Nine patients had complete lysis, and nine patients had partial lysis of the thrombus with improved flow distal to the location of the thrombus. None of the patients developed intracranial hemorrhage. Conclusion For strokes associated with intraluminal thrombus, intravenous heparin might prove to be an effective treatment strategy. Further studies are necessary to evaluate the efficacy and safety of treatment with intravenous heparin in those patients.