[Secondary prevention of cerebral embolism of cardiac origin].
About 20% of cerebral ischemic strokes are the consequence of embolism arising from the heart. Their secondary prevention is based on the treatment of the causal heart disease, which is most often associated with an anticoagulant treatment. In case of nonrheumatismal atrial fibrillation (AF), the most frequent cause of cerebral embolism of cardiac origin, the benefits of a long-standing anticoagulant treatment in comparison with a placebo or with aspirin for the prevention of recurrence is being investigated in a European multicenter trial. However, considering the very favorable results reported recently for primary prevention, it seems logical to think that many patients with nonrheumatismal AF will also benefit from this treatment as secondary prevention. The optimal delay to begin an anticoagulant during the acute phase of cardioembolic brain infarcta remains controversial. Physicians must weight the spontaneous risk of embolic recurrence against the risk of symptomatic brain hemorrhage with anticoagulants (caused by worsening of a spontaneous hemorrhagic transformation) for the individual patients. Recommendations of the Cerebral Embolism Study Group include delaying the start of the heparin course by 48 hours or more after checking for hemorrhage on CT. In case of large infarction, of hemorrhagic infarction or of uncontrolled arterial hypertension, it seems safer to delay the treatment for at least a week. However, these are only empirical recommendations, which must be adapted to each case according to the individual risks.
Mas
J L
JL
Service de Neurologie, Centre R.-Garcin, Hôpital Sainte-Anne, Paris.
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D006331:Heart Diseases / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012008:Recurrence; D012307:Risk Factors
D000925:Anticoagulants
Prévention secondaire des embolies cérébrales d'origine cardiaque.