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How is heparin used to treat a stroke or a transient ischemic attack (TIA)?

Antithrombotic drugs (also known as anticoagulants or blood thinners) help prevent the formation of blood clots. In the acute phase therapy for ischemic stroke, doctors typically use heparin -- delivered intravenously or by injection -- for this purpose.

Doctors consider using intravenous heparin when clot-dissolving (thrombolytic) therapy is not given or, in selected cases, immediately after intra-arterial clot retrieval in order to keep the blood vessel open. Intravenous heparin is most often used in treating stroke or transient ischemic attacks (TIA) caused by a narrowing in a major artery, such as the carotid artery, the middle cerebral artery, the distal vertebral artery, or the basilar artery, where further clotting and embolization are likely to occur.

Doctors also consider using this drug to treat embolic stroke if thrombolytic therapy is not given, particularly when the embolic clot is thought to still be in the brain artery before it dissolves naturally. Because there hasn't been a large clinical study of heparin in which the precise cause of the stroke or TIA was documented, proof of its effectiveness is lacking. Therefore, doctors must evaluate each situation on a case-by-case basis. It may be useful when the cause of stroke or TIA is a clot blocking a major artery in the neck or at the base of the brain that could expand and cause more damage.

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