This research endeavors to quantify the incidence of hemorrhagic transformation, intracranial complications, and systemic bleeding among acute ischemic stroke patients (both embolic and thromboembolic types) receiving unfractionated heparin as a bridging therapy. Furthermore, we sought to delineate the demographic, clinical, and radiological factors heightening the hemorrhagic risk.

A meticulous retrospective examination was conducted on records of adults (>18 years) administered with a heparin infusion during the acute phase of their stroke from 2019-2022.

Of the 465 patients (F:M:1.25:1) studied, intracranial hemorrhage was seen in 3.2%, secondary hemorrhagic transformation in 14%, and systemic bleeding in 4% during the heparin infusion. Intriguingly, prior use of anticoagulation (p=0.023), poorly controlled diabetes mellitus (p=0.047), embolic strokes (p=0.02), and those with larger stroke area (p<0.001 significantly elevated bleeding risks. Moreover, patients on heparin exhibited a significantly longer hospital stay (p=0.001) averaging 13 days, 5 more days compared those with no bleed.Multivariate logistic regression pinpointed larger infarct area (OR=2.74, 95% CI:1.47-4.15, p<0.001), prior anticoagulant therapy (OR=1.923, 95% CI:1.042- 3.559, p=0.03), embolic event (OR=1.927, 95% CI:1.04-3.54, p=0.03), and poorly controlled diabetes mellitus (OR=2.07, 95% CI:1.15-3.73, p=0.01) as key contributors to heightened hemorrhagic complications.

In acute ischemic stroke patients, unfractionated heparin administration, while beneficial in select settings, warrants prudence. It poses a considerable hemorrhagic risk, particularly in patients with larger infarct areas, prior anticoagulant exposure, embolic phenotypes, and uncontrolled diabetes.