MANIPULATION OF COAGULATION-FACTORS IN ACUTE STROKE

In patients with an acute cerebral infarction, anticoagulation may spa re tissue in the ischaemic penumbra from irreversible necrosis by prev enting thrombus extension from a vascular bed with good collateral cir culation to one with poor collateral circulation. In addition to the p ossibility of limiting infarct volume, anticoagulation may be given ac utely to prevent early recurrent cerebral infarction or to prevent or treat thrombus outside the nervous system (i.e. deep venous thrombosis or pulmonary embolus). In one controlled trial of a low molecular wei ght heparin, administration of nadroparin calcium within 48 hours of o nset of cerebral infarction decreased the combined incidence of depend ency and all-cause mortality at 6 months. Another controlled trial in patients with cerebral venous thrombosis demonstrated the benefit of c ontinuous intravenous adjusted-dose unfractionated (UF) heparin compar ed with placebo. Although results of anticoagulation appear promising in patients with acute cerebral infarction and cerebral venous thrombo sis, the benefits of these agents remain unconfirmed. The results of l arge multicentre trials using a heparinoid (ORG 10172) and subcutaneou s UF heparin in patients with acute cerebral infarction are expected w ithin the year.