Antithrombotic therapy in cerebrovascular disease

Article Abstract:

Stroke is one of the most common disabling illnesses affecting older people. It is also one of the most feared, since many of the abilities required for daily living, including speech, may be rapidly and irreversibly impaired. Many strokes arise in a manner analogous to a heart attack: an artery becomes occluded by a thrombus or blood clot, and the occlusion causes ischemia, the reduction of blood flow to part of the brain and subsequent deprivation of oxygen. If the ischemia is not resolved rapidly, the irreversible damage of a cerebral infarction is the result. It might seem reasonable to treat strokes in the same ways that heart attacks are treated, that is, with drugs to dissolve clots or to reduce their formation or progression. However, strokes may arise from a variety of causes, and no simple statements about the best treatment are possible. The author provides a detailed review of the role of anticoagulant therapy in patients with cerebrovascular disease. It is clear that thrombolytic enzymes like streptokinase save lives of heart attack victims by helping dissolve the blood clot. However, these same enzymes may contribute to the risk of an intracerebral hemorrhage if used to treat a cerebral infarction. Aspirin, which reduces the risk of clotting, may prove useful in the treatment of strokes, but few data exist to indicate whether it is better or worse than other agents. Heparin, a far stronger inhibitor of clotting, may help some patients and cause cerebral hemorrhages as a dreaded side effect in others. Unfortunately, simple judgments cannot be made; the risk of hemorrhage must be balanced against the possible effects of a progressing stroke. Similar considerations apply to TIAs, or transient ischemic attacks. These are momentary failures of circulation, perhaps comparable to angina in the heart. TIAs are extremely grave prognostic indicators, however, and patients with TIAs have a long term annual risk of developing a stroke of about 5 percent. (Patients with TIAs are very likely to suffer heart attacks as well.) Should TIA patients be treated with regular aspirin or with other anticoagulants? The author suggests that an aspirin a day might be recommended to TIA patients; an important part of therapy, however, is the management of risk factors for atherosclerosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Anticoagulants (Medicine), Anticoagulants, Cerebrovascular disease, Cerebrovascular disorders, Thrombolytic therapy, Heparin

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Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation: A Meta-Analysis

Article Abstract:

Use of warfarin and aspirin in patients with atrial fibrillation can reduce the incidence of stroke, with warfarin being much more effective than aspirin. Even though there were occurrences of major hemorrhaging in patients in the trials, the benefit still outweighed the risks. Analysis of 16 trials with a total of 9,874 participants indicated that adjusted-dose warfarin reduced stroke by 62%, with absolute risk reductions of 2.7% per year for primary prevention and 8.4% per year for secondary prevention. Aspirin reduced stroke by 22% with absolute risk reductions of 1.5% per year for primary prevention and 2.5% per year for secondary prevention.

Complications and side effects, Risk factors

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Atrial Fibrillation and Thromboembolism: A Decade of Progress in Stroke Prevention

Article Abstract:

Medical ability to prevent stroke has advanced greatly in the past decade or so, with an improved understanding of thromboembolism and its relation to atrial fibrillation allowing many opportunities for stroke prevention. Atrial fibrillation multiplies the risk of stroke by six times. The use of warfarin to reduce risk is even more effective than aspirin for the same reason, reducing it about 40% more. The ability to identify those patients who will most benefit from anticoagulants has helped improve outlooks tremendously, such as elderly patients who have recurring bouts of atrial fibrillation.

Prevention

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