Anticoagulant and Thrombolytic Therapy for Cerebral Embolism of Cardiac Origin

A retrospective review of 30 patients with acute cerebral embolism of nonseptic cardiac origin was conducted. Two groups of nine patients received either anticoagulant or thrombolytic therapy, such as urokinase. 12 patients received no drug therapy. Early recurrence of cerebral embolism occurred in one of the 12 patients without drug therapy. A hemorrhagic infarction diagnosed by a CT scan was observed from one day to day 32 in four of nine patients on anticoagulant therapy (44.4%), five patients receiving urokinase (55.6%) and five patients without therapy (41.7%). At the time of identification of the hemorrhage, four patients were receiving either anticoagulant or thrombolytic therapy. The hemorrhage occurred in six of nine patients (66.7%) with rheumatic valve disease. It should be noted that all four patients with rheumatic valve disease who received anticoagulant therapy had hemorrhagic infarctions. Two of the four patients displayed catastrophic outcomes. In contrast, hemorrhagic infarctions occurred in only six of 19 patients (31.6%) with non-valvular atrial fibrillation. It is concluded from the above findings that anticoagulant therapy should be avoided during the first month after a cerebral embolism caused by rheumatic valve disease.