Anticoagulation and hemorrhagic infarction in cerebral embolism secondary to rheumatic heart disease
L. Calandre, J. F. Ortega and F. Bermejo
The immediate clinical course of 42 patients with cerebral embolism
secondary to rheumatic heart disease (RHD) was analyzed retrospectively.
All the cases included cranial computed tomographic (CT) findings.
Twenty-five patients received early anticoagulant therapy (AT) and 17 did
not. Recurrent embolic events occurred in only one case. Seven instances of
hemorrhagic infarction (HI) were found. In five cases, the development of
HI correlated with a recurrent stroke, which occurred in each case within
48 hours after the initial cerebral embolism. Three of the patients with HI
died (all of them were receiving AT). We believe that HI is a frequent
cause of recurrent stroke after a cerebral embolic event, that it generally
occurs in the first 48 hours, and that its outcome is possibly worsened by
AT. Anticoagulant therapy should be delayed for three days after a cerebral
embolic event secondary to RHD.
