Anticoagulants in cerebrovascular disease. A critical review of studies

Anticoagulant therapy in the treatment of cerebral thromboembolism remains controversial despite 20 years of statistical studies. Among the unresolved questions are (1) the relative value of aspirin vs coumarin derivatives for long-term therapy; (2) the relative benefits of long-term therapy vs short-term therapy; (3) the complications of anticoagulant therapy vs their therapeutic benefits; and (4) the optimal therapy of the various types of cerebral thromboembolic events, eg, transient ischemic attacks, strokes in evolution, and completed strokes. Much of this controversy derives from the same problems that have plagued the question of anticoagulation for acute myocardial infarction, namely that "the existing statistics were obtained without adequate attention to fundamental principles of clinical science". We have examined the available clinical studies bearing on this issue and are reporting our analysis of these studies.