Artikel
The usefulness and safeness of anticoagulation therapy in the acute phase for cardiogenic brain embolism
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Autoren
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M. Satoru
- Department of Neurosurgery, Gifu prefectural general medical center, Gifu, Japan
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T. Kawasaki
- Department of Neurosurgery, Gifu prefectural general medical center, Gifu, Japan
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S. Sakai
- Department of Neurosurgery, Gifu prefectural general medical center, Gifu, Japan
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Y. Kotani
- Department of Neurosurgery, Gifu prefectural general medical center, Gifu, Japan
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T. Kuroda
- Department of Neurosurgery, Gifu prefectural general medical center, Gifu, Japan
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M. Kumagai
- Department of Neurosurgery, Gifu prefectural general medical center, Gifu, Japan
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Although anticoagulation therapy (AC) is necessary to prevent the recurrence of cardiogenic brain embolism, we have no consensus about the timing to start AC or the propriety of AC according to the extent of the infarction. In this study, we examined retrospectively the therapeutic methods for cardiogenic brain embolism in the acute phase, and how did the methods influence to the clinical course.
Methods: Among 367 consecutive patients with acute brain ischemia admitted to our institute between August 1st 2010 and October 31st 2011, 65 patients (17.7%) were diagnosed as cardiogenic brain embolism. About these 65 patients, we examined retrospectively the fundamental cardiac disease, drug therapy up to the admission, therapeutic methods in the acute phase and clinical course. The extent of infarction was estimated according to the ASPECTS-DWI.
Results: Among 65 patients diagnosed as cardiogenic brain embolism,53 patients had nonvalvular atrial fibrillation, and other 12 patients had another cardiac disease. Twenty three patients (35.4%) had oral anticoagulant up to the admission, and the average value of PTINR on admission of these patients was 1.75. Fifty four patients received anticoagulation therapy in the acute phase, and among them 28 patients and 23 patients were treated with heparin and warfarin administration, respectively. Only two patients had a recurrence of embolism within two weeks, and these cases had not received AC. Ten patients developed hemorrhagic infarction, and 7 of those ten patients had received AC in the acute phase. The average of estimated point of ASPECTS-DWI in these 10 patients was 5.98, and those patients had relatively large range of infarction. Among these 10 patients with hemorrhagic infarction, only 2 patients had relatively large hematoma, and another 8 patients had slight bleeding without mass effect.
Conclusions: In the patients of cardiogenic brain embolism, AC may produce hemorrhagic infarction, but most were slight bleeding, and an early anticoagulation therapy was recommended to prevent re-embolism.
