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Stroke. 2016 Jun;47(6):1577-83. doi: 10.1161/STROKEAHA.116.012639. Epub 2016 Apr 26.

Impact of Guidelines on Clinical Practice: Intravenous Heparin Use for Acute Ischemic Stroke.

Author information

1
From the Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-W.C.); Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.J.K., M.-K.H., M.S.J., H.-J.B.); Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Republic of Korea (Y.K., S.J.L.); Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Republic of Korea (K.K., J.-M.P.); Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea (S.-S.P., T.H.P.); Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea (Y.-J.C., K.-S.H.); Department of Neurology, Soonchunhyang University Hospital, Seoul, Republic of Korea (K.B.L.); Department of Neurology, Yeungnam University Hospital, Daegu, Republic of Korea (J.L.); Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea (W.-S.R., D.-E.K.); Department of Neurology, Dong-A University Hospital, Pusan, Republic of Korea (H.-W.N., D.-H.K., J.-K.C.); Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K., K.-H.C.); Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea (J.C.C.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (M.-S.O., K.-H.Y., B.-C.L.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea (J.L.); Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Mercy Health Hauenstein Neurosciences, Grand Rapids, MI (P.B.G.); and Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (B.-W.Y.).
2
From the Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-W.C.); Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.J.K., M.-K.H., M.S.J., H.-J.B.); Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Republic of Korea (Y.K., S.J.L.); Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Republic of Korea (K.K., J.-M.P.); Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea (S.-S.P., T.H.P.); Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea (Y.-J.C., K.-S.H.); Department of Neurology, Soonchunhyang University Hospital, Seoul, Republic of Korea (K.B.L.); Department of Neurology, Yeungnam University Hospital, Daegu, Republic of Korea (J.L.); Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea (W.-S.R., D.-E.K.); Department of Neurology, Dong-A University Hospital, Pusan, Republic of Korea (H.-W.N., D.-H.K., J.-K.C.); Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K., K.-H.C.); Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea (J.C.C.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (M.-S.O., K.-H.Y., B.-C.L.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea (J.L.); Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Mercy Health Hauenstein Neurosciences, Grand Rapids, MI (P.B.G.); and Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (B.-W.Y.). jyleeuf@korea.ac.kr braindoc

Abstract

BACKGROUND AND PURPOSE:

Since its introduction, controversy has existed about the administration of intravenous heparin for the treatment of acute ischemic stroke. We studied trends in the intravenous heparin use during a 6-year time period and the potential influence of clinical guidelines in national language on intravenous heparin administration in Korea.

METHODS:

On the basis of a prospective nationwide multicenter stroke registry, we collected data on patients with acute ischemic stroke who arrived within 7 days of symptom onset during the time period 2008 to 2013. We studied patient demographics, prestroke medical history, stroke characteristics, and stroke treatment. Data from a total of 23 425 patients from 12 university hospitals or regional stroke centers were analyzed.

RESULTS:

The administration of intravenous heparin steadily decreased throughout the study period: 9.7% in 2008, 10.9% in 2009, 9.4% in 2010, 6.0% in 2011, 4.7% in 2012, and 4.3% in 2013 (P for trend <0.001). The reduced intravenous heparin use was associated with moderate stroke severity, atrial fibrillation, and stroke of cardioembolic, other-, and undetermined etiology. In a multivariable logistic model, increase of 1 calendar year (odds ratio, 0.89; 95% confidence interval, 0.84-0.95; P<0.001) and release of clinical practice guidelines in Korean (odd ratio, 0.74; 95% confidence interval, 0.59-0.91; P<0.01) were independent factors associated with reduction in the frequency of intravenous heparin use.

CONCLUSIONS:

Use of intravenous heparin for acute ischemic stroke treatment has decreased in Korea, and this change may be attributable to the spread and successful implementation of regional clinical practice guidelines.

KEYWORDS:

cerebral infarction; guideline adherence; heparin; stroke; trends

PMID:
27118793
DOI:
10.1161/STROKEAHA.116.012639
[Indexed for MEDLINE]

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