A benefit/risk analysis of the prevention of brain ischaemia with anticoagulant drugs: when, how and whom to treat?
This paper summarises the benefits and risks of anticoagulant treatment in patients who have had cerebral ischaemia. In patients with a cardiac source of embolism (in most studies atrial fibrillation), anticoagulation with a target intensity of an INR of 2.0--3.0 is the therapy of first choice. In the case of a contraindication to such treatment, aspirin and ibuprofen are safe, but less effective alternatives. In patients with cerebral ischaemia of presumed arterial origin, anticoagulation with an achieved intensity of 3.0--4.5 proved not to be safe. Results from trials with more moderate anticoagulation regimes are awaited.
University Department of Neurology and Julius Center for Patient Oriented Research, University Medical Center Utrecht, Utrecht, The Netherlands. A.Algra@neuro.azu.nl
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D000925:Anticoagulants / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D018570:Risk Assessment
D000925:Anticoagulants