[Anticoagulation and antiaggregation: implication in the acute phase of stroke following IST, CAST, TOAST, FISS and FISS bis].
BACKGROUND
One of the therapeutic strategies in the acute phase of cerebral ischaemia is the use of antiaggregants and anticoagulants.


METHODS
Until recently, their clinical use was empirical. It was based on the favourable results of clinical trials using these drugs in acute coronary ischaemia and the results of some preliminary clinical trials (although not the definitive trials) in the acute phase of cerebral infarct. These involved a small number of patients and randomization errors which did not definitely show the benefit/risk ratio, particularly in cases of bleeding of any origin. However, they served as a basis for further studies. Therefore, IST was done using anticoagulants in a large number of patients. It was randomized and open, using subcutaneous non-fractionated heparin without a TPT control. Use of heparin was associated with a significant number of haemorrhages without obvious net benefit, so should not be used in these conditions. Other trials used heparinoids (TOAST) or low molecular weight heparin (FISS and repeat FISS) and showed no benefit either. IST and CAST are trials involving antiaggregants. They included larger numbers of patients using an open, randomized design. The results showed benefit, with reduction in the early recurrence of ischemia, death and dependence. There was also a significant, but not very relevant, increase in recovery.


CONCLUSIONS
In view of this data Aspirin in doses of 160-300 mg/d during the first 48 hours after onset of the cerebral infarct has been recommended.
Muñoz-Torrero
J J
JJ
Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, España.
Díez-Tejedor
E
E
D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors