Abstract

*Dr. Akshay Deepak, Dr. Thamanna and Dr. Deepak Arjundas

ABSTRACT

Background: Ischemic stroke remains a leading cause of morbidity and mortality worldwide, necessitating effective therapeutic strategies to prevent thrombus formation and improve outcomes. This study evaluates the safety of heparin loading doses combined with dual antiplatelet therapy (DAPT) as initial therapy in ischemic stroke patients, with a focus on bleeding complications. Methods: A prospective, observational study was conducted at a tertiary care hospital involving 100 patients diagnosed with acute ischemic stroke within 24 hours of symptom onset. Patients received a heparin loading dose combined with DAPT (aspirin and clopidogrel). Exclusion criteria included active bleeding, high bleeding risk, contraindications to heparin or antiplatelet agents, severe renal/hepatic impairment, and a history of hemorrhagic stroke. Data on demographic and clinical characteristics, stroke severity (NIHSS score), treatment timing, and bleeding events (major and minor) were collected and analyzed. Results: The study population had a mean age of 65.3 ± 8.7 years, with 60% male predominance. Comorbidities included hypertension (75%), diabetes mellitus (45%), smoking history (35%), and prior stroke (20%). The mean time from symptom onset to treatment was 6.2 ± 2.1 hours, and the mean NIHSS score was 12.5 ± 4.3, indicating moderate stroke severity. Bleeding complications were observed in 45% of patients, with 15% experiencing major bleeding (intracranial and gastrointestinal hemorrhages) and 30% experiencing minor bleeding (bruising, epistaxis). A significant difference (p < 0.0001) was observed between patients with and without bleeding events, highlighting the influence of clinical characteristics on outcomes. Conclusion: The combination of heparin loading doses with DAPT demonstrates a relatively favorable safety profile in acute ischemic stroke, with 55% of patients experiencing no bleeding complications. However, the risk of bleeding remains significant, particularly in patients with predisposing factors such as hypertension and diabetes. Individualized treatment strategies, close monitoring, and comprehensive management of comorbid conditions are essential to optimize outcomes. Future research should focus on larger, long-term studies and the evaluation of newer antiplatelet agents to refine treatment approaches.