Use of intravenous heparin by north American neurologists

Do the data matter?

Ahmad Al-Sadat, Mohammad Sunbulli, Seemant Chaturvedi

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background and Purpose - Our aim was to determine current usage patterns of intravenous heparin for patients with acute ischemic stroke. Methods - A survey was undertaken of 280 neurologists from the United States and 270 neurologists from Canada. Brief vignettes were presented for the following 5 scenarios: stroke in evolution, atrial fibrillation-related stroke (A FIB), vertebrobasilar stroke, carotid territory stroke, and multiple transient ischemic attacks. The effect of medicolegal factors was also ascertained. Statistical comparisons were done with chi-squared testing. Results - US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin for patients with stroke in evolution (51% versus 33%, P<0.001), vertebrobasilar stroke (30% versus 8%, P<0.001), carotid territory stroke (31% versus 4%, P<0.001), and multiple transient ischemic attacks (47% versus 9%, P<0.001). The vast majority of US and Canadian neurologists would use intravenous heparin for acute stroke patients with A FIB (88% and 84%, respectively). US neurologists more often cited medicolegal factors as a potential influence on the decision-making process than Canadian neurologists (33% versus 10%, P<0.001). Conclusions - In several clinical scenarios, US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin. Fears regarding medicolegal consequences may partially explain the treatment disparity. Despite the publication of 4 clinical trials, which have not shown any long-term benefit for patients with acute stroke and A FIB (International Stroke Trial, Heparin in Acute Embolic Stroke Trial) or cardioembolic stroke (Trial of Org 10172 in Acute Stroke Treatment, the Tinzaparin in Acute Ischemic Stroke Trial), both US and Canadian neurologists would use intravenous heparin in large numbers for this condition. Further studies are warranted to investigate the lack of impact of "negative" studies on clinician behavior.

Original languageEnglish (US)
Pages (from-to)1574-1577
Number of pages4
JournalStroke
Volume33
Issue number6
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Heparin
Stroke
Atrial Fibrillation
Neurologists
Transient Ischemic Attack
Fear
Canada
Publications
Decision Making

Keywords

  • Heparin
  • Heparin, low-molecular-weight
  • Heparinoids
  • Jurisprudence
  • Stroke, acute ischemic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Use of intravenous heparin by north American neurologists : Do the data matter? / Al-Sadat, Ahmad; Sunbulli, Mohammad; Chaturvedi, Seemant.

In: Stroke, Vol. 33, No. 6, 2002, p. 1574-1577.

Research output: Contribution to journalArticle

Al-Sadat, Ahmad ; Sunbulli, Mohammad ; Chaturvedi, Seemant. / Use of intravenous heparin by north American neurologists : Do the data matter?. In: Stroke. 2002 ; Vol. 33, No. 6. pp. 1574-1577.
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abstract = "Background and Purpose - Our aim was to determine current usage patterns of intravenous heparin for patients with acute ischemic stroke. Methods - A survey was undertaken of 280 neurologists from the United States and 270 neurologists from Canada. Brief vignettes were presented for the following 5 scenarios: stroke in evolution, atrial fibrillation-related stroke (A FIB), vertebrobasilar stroke, carotid territory stroke, and multiple transient ischemic attacks. The effect of medicolegal factors was also ascertained. Statistical comparisons were done with chi-squared testing. Results - US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin for patients with stroke in evolution (51{\%} versus 33{\%}, P<0.001), vertebrobasilar stroke (30{\%} versus 8{\%}, P<0.001), carotid territory stroke (31{\%} versus 4{\%}, P<0.001), and multiple transient ischemic attacks (47{\%} versus 9{\%}, P<0.001). The vast majority of US and Canadian neurologists would use intravenous heparin for acute stroke patients with A FIB (88{\%} and 84{\%}, respectively). US neurologists more often cited medicolegal factors as a potential influence on the decision-making process than Canadian neurologists (33{\%} versus 10{\%}, P<0.001). Conclusions - In several clinical scenarios, US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin. Fears regarding medicolegal consequences may partially explain the treatment disparity. Despite the publication of 4 clinical trials, which have not shown any long-term benefit for patients with acute stroke and A FIB (International Stroke Trial, Heparin in Acute Embolic Stroke Trial) or cardioembolic stroke (Trial of Org 10172 in Acute Stroke Treatment, the Tinzaparin in Acute Ischemic Stroke Trial), both US and Canadian neurologists would use intravenous heparin in large numbers for this condition. Further studies are warranted to investigate the lack of impact of {"}negative{"} studies on clinician behavior.",
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AB - Background and Purpose - Our aim was to determine current usage patterns of intravenous heparin for patients with acute ischemic stroke. Methods - A survey was undertaken of 280 neurologists from the United States and 270 neurologists from Canada. Brief vignettes were presented for the following 5 scenarios: stroke in evolution, atrial fibrillation-related stroke (A FIB), vertebrobasilar stroke, carotid territory stroke, and multiple transient ischemic attacks. The effect of medicolegal factors was also ascertained. Statistical comparisons were done with chi-squared testing. Results - US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin for patients with stroke in evolution (51% versus 33%, P<0.001), vertebrobasilar stroke (30% versus 8%, P<0.001), carotid territory stroke (31% versus 4%, P<0.001), and multiple transient ischemic attacks (47% versus 9%, P<0.001). The vast majority of US and Canadian neurologists would use intravenous heparin for acute stroke patients with A FIB (88% and 84%, respectively). US neurologists more often cited medicolegal factors as a potential influence on the decision-making process than Canadian neurologists (33% versus 10%, P<0.001). Conclusions - In several clinical scenarios, US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin. Fears regarding medicolegal consequences may partially explain the treatment disparity. Despite the publication of 4 clinical trials, which have not shown any long-term benefit for patients with acute stroke and A FIB (International Stroke Trial, Heparin in Acute Embolic Stroke Trial) or cardioembolic stroke (Trial of Org 10172 in Acute Stroke Treatment, the Tinzaparin in Acute Ischemic Stroke Trial), both US and Canadian neurologists would use intravenous heparin in large numbers for this condition. Further studies are warranted to investigate the lack of impact of "negative" studies on clinician behavior.

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