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Cardiogenic brain embolism. The second report of the Cerebral Embolism Task Force
Insights
Cardiogenic embolism is a significant cause of ischemic stroke. Reviewing literature, this study highlights anticoagulation strategies for preventing cardioembolic stroke in various cardiac conditions.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Cardiogenic embolism is a major cause of ischemic stroke, accounting for approximately one in six cases.
- Understanding the natural history, diagnosis, and management of cardioembolic stroke is crucial for effective patient care.
Purpose of the Study:
- To review the current clinical literature on the natural history, diagnosis, and management of cardioembolic stroke.
- To synthesize evidence regarding the efficacy of various anticoagulation strategies for stroke prevention in specific cardiac conditions.
Main Methods:
- Literature review of recent clinical studies on cardioembolic stroke.
- Analysis of data concerning atrial fibrillation, myocardial infarction, mitral valve prolapse, patent foramen ovale, and infective endocarditis.
Main Results:
- Long-term anticoagulation may be beneficial for primary stroke prevention in high-risk non-rheumatic atrial fibrillation patients.
- Heparin reduced left ventricular thrombi post-myocardial infarction, but oral anticoagulation's role for persistent thrombi is debated.
- Two subgroups of mitral valve prolapse exist: benign and embolism-prone.
- Contrast echocardiography aids in diagnosing patent foramen ovale, linked to paradoxical embolism.
- Embolic risk from infective endocarditis is low (<5%) with controlled infection; early embolism doesn't predict later stroke.
- Low-intensity anticoagulation (INR 2.0-3.0) may suffice for many embolism-prone cardiac disorders.
Conclusions:
- Evidence supports tailored anticoagulation strategies for preventing cardioembolic stroke.
- Further research is needed to clarify the role of oral anticoagulation for persistent left ventricular thrombi.
- Early diagnosis and management of conditions like patent foramen ovale and specific mitral valve prolapse types are key to reducing embolic events.
Abstract:
Cardiogenic embolism has accounted for one in six ischemic strokes in recent clinical studies. We review the recent clinical literature about the natural history, diagnosis, and management of cardioembolic stroke. Long-term anticoagulation may be indicated for primary stroke prevention in high-risk patient subgroups with non-rheumatic atrial fibrillation. The prevalence of left ventricular thrombi, and probably also emboli, following an acute anterior myocardial infarction has been reduced by heparin, but the value of subsequent oral anticoagulation for persistent left ventricular thrombi has been disputed. Two clinical subgroups of mitral valve prolapse have been emerging: one benign and the other prone to complications, including embolism. Paradoxical embolism has increasingly been reported as contrast echocardiography has permitted a reliable diagnosis of patent foramen ovale. The embolic risk of infective endocarditis is low (less than 5%) when infection is controlled; early embolism during uncontrolled infection does not strongly predict later stroke. Low-intensity anticoagulation (international normalized ratio, 2.0 to 3.0) may be sufficient prophylaxis for many embolism-prone cardiac disorders.