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Stroke, Vol 14, 658-663, Copyright © 1983 by American Heart Association

ARTICLES

Anticoagulation in cerebral ischemia

BB Weksler and M Lewin

Anticoagulation clearly benefits patients at risk of stroke from cerebral embolism. Conversely, patients with completed ischemic stroke are not benefited, and may show a higher mortality and morbidity because of hemorrhagic complications. Technical advances in the early, accurate diagnosis of cerebral hemorrhage, the constant infusion of heparin, and closer monitoring of anticoagulation have continued to reduce the risk of hemorrhage in treated patients. In patients with TIA, alternative therapy with anti-platelet agents, which appears to prevent stroke at less bleeding risk, is under study. Current results show no differences between the two therapies, but only historical controls are available for evaluation of benefit. Whether or not anticoagulation prevents progression of neurologic deficit in patients with strokes-in-evolution remains an unanswered question, which can be resolved only by prospective, randomized, controlled trials.

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