[Anticoagulants: when, which, how much, until when: these are still the questions.II].
OBJECTIVE
To analyze the different presentations of ischemic cerebrovascular disease and develop algorithms for treatment in those different possible settings.


METHODS
We present an analysis of the publications in which the clinical, diagnostic and therapeutic features of aorto-emboli and cardio-emboli (patent foramen ovale, septal aneurysm, bacterial endocaritis, etc.) have been defined. We suggest an algorithm with general parameters for the use of anticoagulants in cerebrovascular disease. Subsequently we specifically consider the decision as to the moment to start anticoagulation, selection of the type of anticoagulant, dosage, route of administration and duration of the treatment. Because of the implications for treatment, we assess the therapeutic options when haemorrhagic infarcts occur.


CONCLUSIONS
Based on studies in the literature showing benefit in individualized cerebrovascular disorders, and the anecdotic experiences of Drs. Miller Fisher, Caplan, Pessin and the writer, over the past 40 years using anticoagulants in the different clinical settings described, some parameters for treatment are proposed. We emphasize that whilst patients with different types of cerebrovascular disease are all grouped together under the unifying term 'stroke', the various treatments evaluated will probably be shown to be inefficient or deleterious. The line of treatment suggested in this review is based on the definition of the different cerebrovascular scenarios according to their aetiology and mechanisms, so as to obtain the most suitable treatment in each case.
Estol
C J
CJ
Centro Neurológico de Tratamiento y Rehabilitación, Buenos Aires, Argentina. cjestol@infovia.com.ar
D000925:Anticoagulants / Q000494:pharmacology* / Q000627:therapeutic use*; D001927:Brain Diseases / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D006331:Heart Diseases / Q000188:drug therapy*; D006801:Humans
D000925:Anticoagulants