MANAGEMENT OF THROMBOSIS IN STROKE

The management of thrombosis in stroke requires that several questions be answered concerning the diagnosis, aetiology, identification of pr oblems, general and specific aspects of care, and prevention of furthe r vascular events. Stroke is a clinical diagnosis, but cranial compute d tomography (CT) scanning is required where there is diagnostic uncer tainty or cerebral haemorrhage must be excluded. No specific medical t herapies are of proven benefit in acute stroke but several large trial s are currently evaluating promising antithrombotic therapies (antipla telet, anticoagulant and thrombolytic agents). Aspirin has a proven ro le in the prevention of further vascular events after a stroke or tran sient ischaemic attack (TIA). In stroke and TIA patients with non-rheu matic atrial fibrillation, warfarin is highly effective at preventing recurrent events. The risk of recurrent stroke in patients with a symp tomatic, severe carotid artery stenosis is greatly reduced by endarter ectomy.