Feedback from David K. Cundiff, MD

Mrs Hazel Fraser

Review Group Co-ordinator

University of Edinburgh

Division of Clinical Neurosciences

Western General Hospital

Crewe Road

Edinburgh

UK

EH4 2XU

Sent 6/25/07 G Gubitz*, P Sandercock*, C Counsell*. Anticoagulants for acute ischaemic stroke. Cochrane Database of Systematic Reviews. 2004(Issue 3):Art. No.: CD000024.pub000022. DOI: 000010.001002/14651858.CD14000024.pub14651852 (Stroke)

Dear Mrs. Fraser,

Please consider the criticisms below of the Cochrane review of anticoagulant treatment of acute ischaemic stroke.

I certify that I have no affiliations with or involvement in any organisation or entity with a direct financial interest in the subject matter of my criticisms.

Thank you.

Best wishes,

David K. Cundiff, MD

This review of anticoagulant trials, including over 22,000 patients with acute ischemic stroke, found no net benefit with the use of any anticoagulant. Consequently, the implications for practice and implications for research are too timid. The implication for practice should say that anticoagulants should be contraindicated in patients with acute ischemic stroke. The implications for research should say that further trials of anticoagulants in acute ischemic stroke would be unethical.