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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
06:01

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

Published on: August 18, 2015

Changes in cardiac thrombus status after cerebral ischemia

Souvik Sen1, Joao A C Lima, Stephen M Oppenheimer

  • 1Departments of Neurology and Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Md., USA.

Cerebrovascular Diseases (Basel, Switzerland)
|January 7, 2004
PubMed

Insights

Warfarin anticoagulation helped intracardiac thrombi disappear in stroke patients. Older patients and those with aortic atheroma may need prophylactic anticoagulation to prevent new thrombus formation and embolism.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Intracardiac thrombi pose a risk for cerebral embolism in patients with ischemic stroke or transient ischemic attack (TIA).
  • Understanding thrombus disposition is crucial for managing stroke risk.

Purpose of the Study:

  • To investigate the fate of intracardiac thrombi in ischemic stroke/TIA patients over a 10-month period.
  • To evaluate the role of anticoagulation and other risk factors in thrombus resolution and new thrombus formation.

Main Methods:

  • 105 patients with ischemic stroke/TIA underwent transesophageal echocardiography (TEE) at baseline and 9-12 months post-symptom onset.
  • TEE assessments focused on thrombi in the left atrium, left atrial appendage, and left ventricle.
  • Comparisons were made between patients with and without new or resolved thrombi, analyzing stroke risk factors and anticoagulant use.

Main Results:

  • Intracardiac thrombi were initially detected in 18% of patients; 79% of these resolved, significantly correlating with warfarin anticoagulation (p=0.037).
  • New thrombi developed in 8% of patients on follow-up TEE, predominantly in older, non-anticoagulated individuals.
  • Aortic atheroma ≥4 mm was associated with a higher likelihood of new intracardiac thrombus development (p=0.001).

Conclusions:

  • 10-month warfarin anticoagulation appears to promote the disappearance of intracardiac thrombi after cerebral ischemic events, suggesting a therapeutic role.
  • Older, non-anticoagulated patients and those with significant aortic atheroma face an increased risk of de novo thrombus development.
  • These high-risk patients may benefit from prophylactic anticoagulation to mitigate the risk of cardiac embolization.
Abstract

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