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Early anticoagulation after large cerebral embolic infarction: a safety study
1Department of Medicine, Hospital Clinic i Provincial, Barcelona, Spain.
Neurology
|May 1, 1995
Summary
Early anticoagulation for nonseptic embolic stroke is safe regarding bleeding complications, irrespective of stroke severity or infarct size. However, close monitoring of activated partial thromboplastin time (aPTT) is crucial to prevent excessive anticoagulation.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Optimal timing for anticoagulation in nonseptic embolic stroke remains unclear.
- Lack of explicit clinical criteria for initiating anticoagulation after large embolic infarctions.
Purpose of the Study:
- To determine if hemorrhage risk after early anticoagulation in nonseptic embolic infarction correlates with clinical severity and infarct size.
- To evaluate the safety and efficacy of early anticoagulation in embolic stroke patients.
Main Methods:
- 83 patients with hemispheric embolisms received heparin within 72 hours, with activated partial thromboplastin time (aPTT) at 1.5 times control.
- Patients were stratified into high-risk and low-risk groups based on clinical symptoms, Mathew Scale score, and initial CT findings.
- Hemorrhagic complications were assessed using serial CT scans and MRIs.
Main Results:
- Hemorrhagic conversion and worsening were not linked to admission clinical severity or infarct size.
- Hemorrhage was associated with excessive prolongation of aPTT (p < 0.01).
- High-risk patients exhibited more severe deficits and larger infarcts prior to therapy.
Conclusions:
- Early anticoagulation in nonseptic embolic stroke does not increase bleeding risk based on clinical severity or infarct size.
- Delaying anticoagulation treatment appears unjustified when deemed necessary.
- Strict monitoring of aPTT to maintain levels at 1.5 to 2 times control is strongly recommended.