Impact of Guidelines on Clinical Practice Intravenous Heparin Use for Acute Ischemic Stroke
- Authors
- Chung, Jong-Won; Kim, Beom Joon; Han, Moon-Ku; Ko, Youngchai; Lee, SooJoo; Kang, Kyusik; Park, Jong-Moo; Park, Sang-Soon; Park, Tai Hwan; Cho, Yong-Jin; Hong, Keun-Sik; Lee, Kyung Bok; Lee, Jun; Ryu, Wi-Sun; Kim, Dong-Eog; Nah, Hyun-Wook; Kim, Dae-Hyun; Cha, Jae-Kwan; Kim, Joon-Tae; Cho, Ki-Hyun; Choi, Jay Chol; Oh, Mi-Sun; Yu, Kyung-Ho; Lee, Byung-Chul; Jang, Myung Suk; Lee, Ji Sung; Lee, Juneyoung; Gorelick, Philip B.; Yoon, Byung-Woo; Bae, Hee-Joon
- Issue Date
- 6월-2016
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- cerebral infarction; guideline adherence; heparin; stroke; trends
- Citation
- STROKE, v.47, no.6, pp.1577 - U422
- Indexed
- SCIE
SCOPUS
- Journal Title
- STROKE
- Volume
- 47
- Number
- 6
- Start Page
- 1577
- End Page
- U422
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/88503
- DOI
- 10.1161/STROKEAHA.116.012639
- ISSN
- 0039-2499
- 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.
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Collections - College of Medicine > Department of Medical Science > 1. Journal Articles
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