Role of anticoagulants in the treatment of cerebrovascular disease

Since 1955 a number of conflicting reports have appeared concerning the efficacy of anticoagulant agents against cerebrovascular disease. Some of the variation of opinion has been caused by different concepts of what may be accomplished by the treatment and by the fact that clinical categories of strokes may respond differently to therapy. The evidence accumulated to date suggests that anticoagulant therapy may favorably influence the natural history of (1) impending stroke (intermittent focal cerebrovascular insufficiency, transient ischemic attacks), (2) advancing stroke, particularly in the vertebrobasilar system, and (3) recurrent cerebral embolization from a cardiac source. In most reports it is said that anticoagulant therapy is of no benefit when completed stroke is present and under such a circumstance may be unduly dangerous. Hemorrhagic complications continue to be a problem. Careful control of the degree of anticoagulation must be maintained; it may reduce the incidence of complications. Severe systemic hypertension, which cannot be medically controlled, appears to be a contraindication to longterm therapy.