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March 11, 1992

Turning the Tables on Probe Pressures—Go With the Flow, Abandon the Scan?-Reply

Author Affiliations

New England Medical Center Hospitals Boston, Mass

JAMA. 1992;267(10):1341-1342. doi:10.1001/jama.1992.03480100047025

In Reply.  —Dr Fluke is correct. Transcranial Doppler probes measure blood velocities and not pressures as my recent review of this subject stated.1 I thank him for pointing out the error in the figure caption.In my article on stroke, I shared with JAMA readers my present management rules. The rationale for using anticoagulants has been elaborated on elsewhere in more detail.2,3I use heparin-warfarin anticoagulation for some vascular lesions, short term for acute thrombotic oculusions of large arteries, and longer term for cardiogenic embolism and severe flow-reducing stenosis of large arteries. In patients with acute ischemia in either circulation, I often use heparin acutely (when not contraindicated medically) until the cause of the ischemia has been clarified.Unfortunately, the use of anticoagulants or any other treatments for these indications has not been tested scientifically.4 There are no data that support or refute these uses, so clinicians