[Cerebral embolism of cardiac origin: when to anticoagulate?]

In order to decide if i.v. anticoagulation with heparin is indicated in patients with a cerebral infarct from cardiac embolism, the risks of anticoagulant-induced bleeding into the ischemic area must be compared with the risks of embolic recurrence without anticoagulant therapy. Although methodologically imperfect, some studies have reported findings which may help to decide whether to anticoagulate or not. Some risk factors for intracerebral hematoma within the infarct, the most severe complication of anticoagulation, can be identified. The potential benefits also depend upon our ability to establish that a cerebral infarct is in fact due to an embolism from the heart, which is not always possible in the present state of knowledge.