Key result
Anticoagulation timing after embolic stroke in rheumatic heart disease remains uncertain given limited evidence.
Why the study?
The timing of anticoagulation initiation after embolic stroke in patients with rheumatic heart disease remains controversial due to conflicting data on recurrent embolic event frequency.
Challenges small retrospective claims on embolism recurrence; anticoagulation timing after rheumatic stroke remains unresolved.
To the Editor. —The issue of when to initiate anticoagulation following embolic stroke remains controversial. The retrospective study of Calandre et al 1 contributes valuable data in this regard. However, additional, pertinent studies have appeared since preparation of their article, 2-7 prompting further questions about their data and conclusions. The authors concluded that recurrent embolic events are not frequent after embolic strokes secondary to RHD [rheumatic heart disease] and, based on their 17 nonanticoagulated patients, several patients were being treated with platelet-inhibiting drugs, which in some way could help against cerebral 1 This conclusion seems premature because of the small numbers in their study, and it conflicts with other studies (Table). The authors postulated that these studies, carried out before computed tomographic (CT) scans were performed, misdiagnosed hemorrhagic transformation with worsening as early recurrent embolism. However, this seems unlikely to entirely explain the higher rates of
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Robert G. Hart (1985) conducted a letter in Embolic stroke secondary to rheumatic heart disease (n=17). Anticoagulation vs. No anticoagulation was evaluated on Recurrent embolic events. Anticoagulation timing following embolic stroke secondary to rheumatic heart disease remains controversial, as conclusions based on 17 nonanticoagulated patients are deemed premature.
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