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Choice of Antithrombotic Therapy Should Be Based on Thromboemboli Content: Presented at ESC

By Michael J. Worthington

MANNHEIM-HEIDELBERG, GERMANY -- May 18, 2004 -- Analysis of the content of cerebral thromboemboli from cardiac and carotid sources may guide the choice of antithrombotic therapy to prevent stroke, researchers report.

Speaking here May 15^th at the 13^th European Stroke Conference, A. Kuznetsov, MD, National Pirogov Centre of Therapy and Surgery, Moscow, Russia, explained that cerebral emboli can originate in areas far from the focal area, such as the heart valves, heart chamber, and peripheral arteries. These emboli are often made up of different material and are given names based on their content, such as red thromboemboli and white thromboemboli.

To establish the emboli content in different cardiac and carotid sources of cerebral embolism, and estimate which antiplatelet therapy would be most appropriate, Dr. Kuznetsov and colleagues enrolled 49 patients with mechanical prosthetic heart valves (MPHV), 13 patients with non-valvular atrial fibrillation (NVAF), and 65 patients with carotid artery disease (CAD).

Patients underwent transcranial Doppler sonography to detect microembolic signals (MES) in the cerebral vessels and echocardiography (MPHV and NVAF patients only) to detect irregularities in valve function.

The investigators found different types of emboli depending on their source. Red thromboemboli -- consisting of red fibrin clots -- appeared to originate in the heart chambers (NVAF patients), white thromboemboli consisting of platelet aggregates were found in the carotid plaques, red thromboemboli, white thromboemboli, platelet aggregates and gaseous microbubbles were found in MPHV patients.

The researchers noted that red fibrin clots present a major danger to the brain due to their large size and are not associated with MES. Oral anticoagulants are the necessary treatment for red clots. White clots are also dangerous to the brain and are associated with MES. Antiplatelet therapy is the therapy of choice for these thromboemboli, Dr. Kuznetsov said.

The researchers concluded that patients with MPHV and cardiac chamber sources of thromboemboli should be treated with oral anticoagulants. If these patients have MES, they should receive additional antiplatelets, he said, adding that patients with CAD should be treated primarily with antiplatelet agents.


[Presentation title: " Preventive Antithrombotic Therapy in the Patients with Cardiac and Carotid Sources of Cerebral Embolism."]

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