SUMMARYAnticoagulation clearly benefits patients at risk of stroke from cerebral embolism. Con versely, patients with completed ischemic stroke are not benefited, and may show a higher mortality and morbidity because of hemorrhagic complications. Technical advances in the early, accurate diagnosis of cerebral hemorrhage, the constant infusion of heparin, and closer monitoring of anticoagulation have continued to reduce the risk of hemorrhage in treated patients, In patients with TIA, alternative therapy with anti-platelet agents, which appears to prevent stroke at less bleeding risk, is under study. Current results show no differences between the two therapies, but only historical controls are available for evalua tion of benefit. Whether or not anticoagulation prevents progression of neurologic deficit in patients with strokes-in-evolution remains an unanswered question, which can be resolved only by prospective, random ized, controlled trials. analysis of the available literature led to the conclusion that data from randomized prospective trials of anti coagulant use in cerebral ischemia were few, that pa tient numbers were small, and that efficacy of anticoa gulants was either not proven or not deducible, particularly because of inadequate control populations.The current review will demonstrate that although new methods of diagnosis and treatment, and new means of monitoring treatment have been developed, definitive clinical studies have yet to be performed. Therefore, improved methods for differentiating ischemic infarc tion from intracranial hemorrhage, for the administra tion of heparin by infusion rather than bolus injection, for the control of hypertension, and for the monitoring of anticoagulant effect which have become available in the routine care of patients with cerebral ischemia, postdate most of the published major studies of anti coagulation for cerebral ischemia, and need to be in corporated into new trials.While it is generally agreed that thrombosis is an important cause of cerebral ischemia, the thrombotic Hemostatic Function in Patients with Cerebral IshemiaIt is difficult to document hypercoagulability in pa tients with cerebrovascular disease; that is, to fine} signs predictive of a high risk for thrombosis, particu larly imminent thrombosis. 3Plasma coagulatipn fac tors are normally present far in excess of the amounts required for normal blood clotting; elevation of these factors is, therefore, a non-specific finding. On the other hand, activated coagulation factors -evidence of intravascular coagulation -are cleared so rapidly from plasma that their elevation cannot be detected. Moreover, several coagulation factors such as fibrino gen and Factor VIII (anti hemophilic factor) which may be elevated in patients with atherosclerosis, are acute phase reactants whose levels rise with any in flammatory condition such as vasculitis, infection or tissue damage induced by stroke.Platelet hyperactivity is measured by augmented ag gregation or by increased plasma levels of platelet re lease produ...
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