***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Despite doubts about their efficacy and concern about their safety , antithrombotic agents are often used to treat acute ischemic stroke . Recent experience in patients with other thromboembolic disorders suggests that low-molecular-weight heparin , which requires only subcutaneous administration once or twice daily , may be more effective and safer than st and ard ( unfractionated ) heparin . METHODS We conducted a r and omized , double-blind , placebo-controlled trial comparing two dosages of low-molecular-weight heparin with placebo in the treatment of ischemic stroke . Patients were r and omly assigned within 48 hours of the onset of symptoms to receive high-dose nadroparin ( 4100 anti-factor Xa IU twice daily ) , low-dose nadroparin ( 4100 IU once daily ) , or placebo subcutaneously for 10 days . The primary measure of outcome was death or dependency regarding activities of daily living six months after r and omization . Secondary outcomes were death , hemorrhagic transformation of the infa rct ion , and other complications at 10 days , and death or dependency at 3 months . RESULTS A total of 2750 patients were screened for the study . Among 312 patients r and omized , 306 had outcomes that were analyzed at six months . Forty-five patients ( 45 percent ) in the high-dose group , 53 patients ( 52 percent ) in the low-dose group , and 68 patients ( 65 percent ) in the placebo group died or became dependent . There was a significant dose-dependent effect among the three study groups in favor of low-molecular-weight heparin ( P = 0.005 by the chi-square test for trend ) . No significant differences among the groups in the occurrence of secondary outcomes were observed at 10 days . CONCLUSIONS For patients with ischemic stroke treated within 48 hours of the onset of symptoms , low-molecular-weight heparin was effective in improving outcomes at six months BACKGROUND Early mobilisation after stroke is thought to contribute to the effects of stroke-unit care ; however , the intervention is poorly defined and not underpinned by strong evidence . We aim ed to compare the effectiveness of frequent , higher dose , very early mobilisation with usual care after stroke . METHODS We did this parallel-group , single-blind , r and omised controlled trial at 56 acute stroke units in five countries . Patients ( aged ≥18 years ) with ischaemic or haemorrhagic stroke , first or recurrent , who met physiological criteria were r and omly assigned ( 1:1 ) , via a web-based computer generated block r and omisation procedure ( block size of six ) , to receive usual stroke-unit care alone or very early mobilisation in addition to usual care . Treatment with recombinant tissue plasminogen activator was allowed . R and omisation was stratified by study site and stroke severity . Patients , outcome assessors , and investigators involved in trial and data management were masked to treatment allocation . The primary outcome was a favourable outcome 3 months after stroke , defined as a modified Rankin Scale score of 0 - 2 . We did analysis on an intention-to-treat basis . The trial is registered with the Australian New Zeal and Clinical Trials Registry , number ACTRN12606000185561 . FINDINGS Between July 18 , 2006 , and Oct 16 , 2014 , we r and omly assigned 2104 patients to  receive either very early mobilisation  ( n=1054 ) or usual care ( n=1050 ) ; 2083 ( 99 % ) patients were included in the 3 month follow-up assessment . 965 ( 92 % ) patients were mobilised within 24 h in the very early mobilisation group compared with 623 ( 59 % ) patients in the usual care group . Fewer patients in the very early mobilisation group had a favourable outcome than those in the usual care group ( n=480 [ 46 % ] vs n=525 [ 50 % ] ; adjusted odds ratio [ OR ] 0·73 , 95 % CI 0·59 - 0·90 ; p=0·004 ) . 88 ( 8 % ) patients died in the very early mobilisation group compared with 72 ( 7 % ) patients in the usual care group ( OR 1·34 , 95 % CI 0·93 - 1·93 , p=0·113 ) . 201 ( 19 % ) patients in the very early mobilisation group and 208 ( 20 % ) of those in the usual care group had a non-fatal serious adverse event , with no reduction in immobility-related complications with very early mobilisation . INTERPRETATION First mobilisation took place within 24 h for most patients in this trial . The higher dose , very early mobilisation protocol was associated with a reduction in the odds of a favourable outcome at 3 months . Early mobilisation after stroke is recommended in many clinical practice guidelines worldwide , and our findings should affect clinical practice by refining present guidelines ; however , clinical recommendations should be informed by future analyses of dose-response associations . FUNDING National Health and Medical Research Council , Singapore Health , Chest Heart and Stroke Scotl and , Northern Irel and Chest Heart and Stroke , UK Stroke Association , National Institute of Health Research In a group of 60 patients in the acute phase of an ischemic stroke the assumption that low-molecular-weight heparin Kabi 2165 in the dose of 2 X 2,500 anti-Xa units s.c . could prevent thromboembolic complications was tested using a double-blind , placebo-controlled , r and omized trial design . Thirty patients were allocated to each group . Both treatment groups were comparable with regard to neurological status and general condition . In the Kabi 2165 group there were 6 cases of deep venous thrombosis ( DVT ) compared to 15 in the placebo group ( p = 0.05 ) . In the placebo group there were 4 deaths during the trial versus 9 in the Kabi-2165-treated group ( NS ) . Cerebral bleeding complicated 2 cases in the placebo group versus 4 in the Kabi 2165 group ( NS ) . These results indicate that in ischemic stroke patients  Kabi 2165 2 X 2,500 anti-Xa units s.c./24 h reduces the frequency of DVT . Because of the small number of patients it is impossible to evaluate the safety BACKGROUND Venous thromboembolism is a common , potentially avoidable cause of death and morbidity in patients in hospital , including those with stroke . In surgical patients , intermittent pneumatic compression ( IPC ) reduces the risk of deep vein thrombosis ( DVT ) , but no reliable evidence exists about its effectiveness in patients who have had a stroke . We assessed the effectiveness of IPC to reduce the risk of DVT in patients who have had a stroke . METHODS The CLOTS 3 trial is a multicentre parallel group r and omised trial assessing IPC in immobile patients ( ie , who can not walk to the toilet without the help of another person ) with acute stroke . We enrolled patients from day 0 to day 3 of admission and allocated them via a central r and omisation system ( ratio 1:1 ) to receive either IPC or no IPC . A technician who was masked to treatment allocation did a compression duplex ultrasound ( CDU ) of both legs at 7 - 10 days and , wherever practical , at 25 - 30 days after enrolment . Caregivers and patients were not masked to treatment assignment . Patients were followed up for 6 months to determine survival and later symptomatic venous thromboembolism . The primary outcome was a DVT in the proximal veins detected on a screening CDU or any symptomatic DVT in the proximal veins , confirmed on imaging , within 30 days of r and omisation . Patients were analysed according to their treatment allocation . TRIAL REGISTRATION IS RCT N93529999 . FINDINGS Between Dec 8 , 2008 , and Sept 6 , 2012 , 2876 patients were enrolled in 94 centres in the UK . The included patients were broadly representative of immobile stroke patients admitted to hospital and had a median age of 76 years ( IQR 67 - 84 ) . The primary outcome occurred in 122 ( 8·5 % ) of 1438 patients allocated IPC and 174 ( 12·1 % ) of 1438 patients allocated no IPC ; an absolute reduction in risk of 3·6 % ( 95 % CI 1·4 - 5·8 ) . Excluding the 323 patients who died before any primary outcome and 41 without any screening CDU , the adjusted OR for the comparison of 122 of 1267 patients vs 174 of 1245 patients was 0·65 ( 95 % CI 0·51 - 0·84 ; p=0·001 ) . Deaths in the treatment period occurred in 156 ( 11 % ) patients allocated IPC and 189 ( 13 % ) patients allocated no IPC died within the 30 days of treatment period ( p=0·057 ) ; skin breaks on the legs were reported in 44 ( 3 % ) patients allocated IPC and in 20 ( 1 % ) patients allocated no IPC ( p=0·002 ) ; falls with injury were reported in 33 ( 2 % ) patients in the IPC group and in 24 ( 2 % ) patients in the no-IPC group ( p=0·221 ) . INTERPRETATION IPC is an effective method of reducing the risk of DVT and possibly improving survival in a wide variety of patients who are immobile after stroke . FUNDING National Institute of Health Research ( NIHR ) Health Technology Assessment ( HTA ) programme , UK ; Chief Scientist Office of Scottish Government ; Covidien ( MA , USA ) Objectives – To compare the efficacy , safety , and overall risk – benefit profile of enoxaparin and unfractionated heparin ( UFH ) prophylaxis of venous thromboembolic complications in patients with acute ischaemic stroke . Methods – Patients with ischaemic stroke result ing in lower‐limb paralysis lasting for at least 24 h and necessitating bedrest , were r and omized within 48 h of the onset of stroke , and treated with enoxaparin ( 40 mg subcutaneously once daily ) or UFH ( 5000 IU subcutaneously thrice daily ) for 10 ± 2 days . Main outcome measures were deep‐vein thrombosis , pulmonary embolism ( PE ) , death from any cause , intracranial haemorrhage including haemorrhagic infa rct ion , or any other major bleeding . Results – Outcome events occurred within 3 months of stroke in 40/106 patients treated with enoxaparin ( 37.7 % ) and 52/106 patients treated with UFH ( 49.1 % , P = 0.127 ) . Fewer patients treated with enoxaparin ( 14 , 13.2 % ) than with UFH ( 20 , 18.9 % ) had evidence of haemorrhagic transformation of ischaemic stroke . Conclusions – Enoxaparin administered subcutaneously once daily was as safe and effective as subcutaneous UFH given thrice daily in the prevention of thromboembolic events in patients with lower limb paralysis caused by acute ischaemic stroke Background Intracerebral hemorrhage ( ICH ) accounted for 9 % to 27 % of all strokes worldwide in the last decade , with high early case fatality and poor functional outcome . In view of recent r and omized controlled trials ( RCTs ) of the management of ICH , the European Stroke Organisation ( ESO ) has up date d its evidence -based guidelines for the management of ICH . Method A multidisciplinary writing committee of 24 research ers from 11 European countries identified 20 questions relating to ICH management and created recommendations based on the evidence in RCTs using the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach . Results We found moderate- to high- quality evidence to support strong recommendations for managing patients with acute ICH on an acute stroke unit , avoiding hemostatic therapy for acute ICH not associated with antithrombotic drug use , avoiding graduated compression stockings , using intermittent pneumatic compression in immobile patients , and using blood pressure lowering  for secondary prevention . We found moderate- quality evidence to support weak recommendations for intensive lowering of systolic blood pressure to < 140 mmHg within six-hours of ICH onset , early surgery for patients with a Glasgow Coma Scale score 9–12 , and avoidance of corticosteroids . Conclusion These guidelines inform the management of ICH based on evidence for the effects of treatments in RCTs . Outcome after ICH remains poor , prioritizing further RCTs of interventions to improve outcome Summary Background Deep vein thrombosis ( DVT ) and pulmonary embolism are common after stroke . In small trials of patients undergoing surgery , graduated compression stockings ( GCS ) reduce the risk of DVT . National stroke guidelines extrapolating from these trials recommend their use in patients with stroke despite insufficient evidence . We assessed the effectiveness of thigh-length GCS to reduce DVT after stroke . Methods In this outcome -blinded , r and omised controlled trial , 2518 patients who were admitted to hospital within 1 week of an acute stroke and who were immobile were enrolled from 64 centres in the UK , Italy , and Australia . Patients were allocated via a central r and omisation system to routine care plus thigh-length GCS ( n=1256 ) or to routine care plus avoidance of GCS ( n=1262 ) . A technician who was blinded to 
    Output:
    
Where a judgement has been made that prophylactic anticoagulation is indicated LMWH or heparinoid should be considered instead of UFH because of its greater reduction in risk of DVT , the greater convenience , reduced staff costs and patient comfort associated single vs. multiple daily injections but these advantages should be weighed against the higher risk of extracranial bleeding , higher drug costs and risks in elderly patients with poor renal function  associated with LMWH and heparinoids .
Conclusions IPC , UFH or LMWH and heparinoids can reduce the risk of VTE in immobile patients with acute ischaemic stroke but further research is required to test whether NES is effective .
The strongest evidence is for IPC .