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QJM Advance Access originally published online on January 17, 2005
QJM 2005 98(2):147-152; doi:10.1093/qjmed/hci014
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QJM vol. 98 no. 2 © Association of Physicians 2005; all rights reserved.

Commentary

Heparin use in acute ischaemic stroke: does evidence change practice?

M. Benatar

From the Department of Neurology, Emory University, Atlanta, USA

The first 150 words of the full text of this article appear below.


   Introduction
 
There has been much discussion in recent years about the importance of evidence-based medicine and, although the discipline has received broad acceptance, it is not without its critics. An important question that has received relatively little attention is: what is the evidence that evidence-based medicine has had any effect on practice? In this article, I shall try to answer this question with respect to the use of heparin in the management of acute ischaemic stroke. I will not consider the unusual instances of extra-cranial arterial dissection, cerebral venous thrombosis and crescendo transient ischaemic attacks, but will instead focus on the more common causes of acute ischaemic stroke for which heparin anticoagulation is still frequently used.

Acute ischaemic stroke is a common problem that carries a significant risk of death and disability. There are approximately 600 000 new cases diagnosed each year in the USA with about 150 000 deaths and . . . [Full Text of this Article]


   Has the evidence had any effect on practice?
 

   Why does the practice of heparin anticoagulation for acute ischaemic stroke persist?
 

   Are neurologists aware of the evidence?
 

   Do neurologists disagree about the interpretation of the evidence?
 

   Does heparin use persist because old habits are hard to break?
 

   Does heparin use persist because of the expectation that it should work?
 

   Does personal experience trump the evidence?
 

   Do medico-legal considerations influence neurologists’ practice?
 

   Are there psychological factors that contribute to the persistent use of heparin?
 

   Conclusion
 

Address correspondence to Dr M. Benatar, Department of Neurology, Emory University, 1365A Clifton Rd NE, Atlanta, GA 30322, USA. e-mail: mbenata@emory.edu


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