Anti-platelet and anti-coagulant therapy for acute cerebral events.

Therapeutical trials in the acute phase of stroke have showed a moderate be nefit of administration of aspirin in prevention of death or recurrent cere bral events. This benefit was obtained despite a small increase in systemic and cerebral haemorrhages. Heparin used at high dosage, without any contro l of coagulation test, induces an excess of cerebral and systemic haemorhag e which overset its benefit in prevention of recurrent cerebral events. Sim ilar results have been observed with heparinoid and nadroparine used at hig h dosage. The only benefit of anticoagulation is the prevention of total an d fatal pulmonary embolism which has been observed in all recent studies. T he anti-thrombotic treatment which offers the best ratio benefit-risk in th e acute phase of stroke is aspirin at a minimum dosage of 160 mg by day and , if risk factors are present, heparin at an adequate dosage to prevent-ven ous thrombo-embolism. Explicative studies are required to explore the poten tial benefit of heparin in patients with a high risk of recurrent cerebral ischemic events.