Anticoagulation and hemorrhagic infarction in cerebral embolism secondary to rheumatic heart disease

The immediate clinical course of 42 patients with cerebral embolism secondary to rheumatic heart disease (RHD) was analyzed retrospectively. All the cases included cranial computed tomographic (CT) findings. Twenty-five patients received early anticoagulant therapy (AT) and 17 did not. Recurrent embolic events occurred in only one case. Seven instances of hemorrhagic infarction (HI) were found. In five cases, the development of HI correlated with a recurrent stroke, which occurred in each case within 48 hours after the initial cerebral embolism. Three of the patients with HI died (all of them were receiving AT). We believe that HI is a frequent cause of recurrent stroke after a cerebral embolic event, that it generally occurs in the first 48 hours, and that its outcome is possibly worsened by AT. Anticoagulant therapy should be delayed for three days after a cerebral embolic event secondary to RHD.