Background and Purpose: The use of intravenous(IV) heparin in acute ischemic stroke has been an area of great controversy. We sought to get the current practice patterns of Korean board certificated neurologists(KBCN) with regard to heparin use in acute ischemic stroke.
Methods: A survey was taken of 657 KBCNs. The e-mail address and subspecialty were obtained from both the History of Korean Neurological Association(1982-2002) and the directory of Korean Stroke Society. Brief vignettes were presented via electronic mailing system for the following five scenarios: progressive stroke, cardiogenic embolism, posterior circulation, external carotid artery stenosis, repetitive TIA. For each vignette respondents were asked whether they would use IV heparin with response choice such as ’yes’, may be’and ‘no’.
Results: Two hundred and thirty three (46.5%) KBCNs returned a completed survey. In progressive stroke, 157 respondents (67.4%) replied ‘yes’, 48 (20.6%) replied ‘maybe’, and 28(12.0%) would not use I.V. heparin. In cardiogenic embolism, 169 respondents (72.5%) replied that they would use, 46 (19.7%) replied maybe, and 18(7.7%) would not use I.V. heparin. In posterior circulation stroke, 122 respondents (52.4%) would use I.V. heparin, 60 (25.8%) maybe use, 51(21.9%) would not use I.V. heparin. In ECA stenosis, 104 respondents (44.6%) would use, 70 (30.0%) maybe use, and 59 (25.3%) would not use I.V. heparin. In repetitive TIA, 173 respondents (74.2%) would use, 29 (12.4%) maybe use, and 31 (13.3%) would not use I.V. heparin. The usage pattern of I.V. heparin in each vignette was not affected by age, current teaching status and subspecialty of stroke. Compared to results found in American study in 2001, KCBNs were significantly more likely to use IV heparin in four clinical scenarios, except in cardiogenic embolism.
Conclusion: Although most therapeutic guidelines for anticoagulants in acute ischemic stroke do not recommend IV heparin for any specific group of acute ischemic stroke that is based on any presumed stroke mechanism or location, Neurologists in Korea would use intravenous heparin in large numbers for these conditions.
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