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Predisposing factors of recurrent embolization in cardiogenic cerebral embolism
M Yasaka1, T Yamaguchi, T Miyashita
1Department of Medicine, National Cardiovascular Center, Osaka, Japan.
Insights
Intracardiac thrombi are common in patients with cerebral embolism. Low antithrombin III levels and dehydration may accelerate thrombus formation and indicate embolism recurrence.
Area of Science:
- Cardiology
- Hematology
- Neurology
Background:
- Intracardiac thrombus formation is a significant concern in patients experiencing acute cardiogenic cerebral embolism.
- Understanding the pathophysiology is crucial for preventing recurrent embolic events.
Purpose of the Study:
- To investigate the pathophysiology of intracardiac thrombus formation in patients with acute cardiogenic cerebral embolism.
- To identify predictors of thrombus development, enlargement, and recurrence.
Main Methods:
- Serial two-dimensional echocardiography was used to detect intracardiac thrombi in 30 patients.
- Hematocrit and antithrombin III levels were measured serially.
- Patients were grouped based on the presence/absence of newly formed or enlarged thrombi.
Main Results:
- Intracardiac thrombi were detected in 27% of patients.
- Low antithrombin III levels at admission were associated with thrombus development/enlargement.
- Decreased inferior vena cava diameter, reduced antithrombin III, and increased hematocrit were observed during thrombus formation/enlargement.
Conclusions:
- Repeated echocardiography frequently detects intracardiac thrombi in patients with cerebral embolism.
- Dehydration appears to accelerate thrombus formation, indicated by decreased antithrombin III.
- Low or decreasing antithrombin III levels may predict recurrent embolism.
Abstract:
To elucidate the pathophysiology of intracardiac thrombus formation, serial two-dimensional echocardiographic examinations were performed on 30 consecutive patients with acute cardiogenic cerebral embolism in parallel with measurement of hematocrit and plasma levels of antithrombin III. The data from groups of patients with and without newly formed or enlarged thrombi were compared. Intracardiac thrombi were detected in eight of the 30 patients (27%), four at admission and four after admission. Enlargement of the thrombus was observed in four, and systemic embolization recurred in three of the eight. Antithrombin III levels already were low at admission in patients who later developed thrombi or had enlarged thrombi on serial examinations. When the development or enlargement of an intracardiac thrombus was detected by echocardiography, the diameter of the inferior vena cava was found to be reduced. At the same time, a decrease in antithrombin III and an increase in hematocrit were demonstrated. Intracardiac thrombi are frequently detected by repeated echocardiographic examination in patients with cerebral embolism. Dehydration seems to accelerate thrombus formation that is reflected by a decrease in antithrombin III. A low antithrombin III level at admission and/or a decrease in antithrombin III after admission may indicate the possible recurrence of embolism.