Anticoagulants for occlusive cerebrovascular lesions

Abstract

Anticoagulants were administered to 55 patients with a presumptive clinical diagnosis of recent occlusive cerebrovascular lesion. No patients were more than slightly hypertensive, and, in all instances, a lumbar puncture prior to therapy revealed no evidence of hemorrhage. With respect to progression of an incomplete lesion, rate of recovery and degree of recovery, the clinical course of these patients was no more favorable than that expected in a similar group treated only by supportive measures. Of these patients, 36% had bleeding in various parts of the body during therapy; this high incidence is not believed to be related simply to the degree of prothrombin depression. It is highly probable that in 4 of these patients, anticoagulation in the therapeutic range was responsible for extensive hemorrhage into the brain with severe deterioration in the patient''s subsequent clinical course. In 3 of these patients, hemorrhage occurred in the region involved by the initial occlusive lesion, and in the fourth,the hemorrhage occupied a different region. The true incidence of this complication may safely be considered to have been higher, since in most patients an adequate search for it was not made. The risk of hemorrhage into the brain appears to contraindicate the use of anticoagulants in the treatment of cerebrovascular lesions under the conditions described in this report.