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January 1, 1968

Anticoagulants and Cerebral Embolism

JAMA. 1968;203(1):59. doi:10.1001/jama.1968.03140010061028

To the Editor:—  The use of anticoagulants in the management of cerebal embolism has been highly controversial, and after studying some of the literature, I have concluded that the evidence is contradictory to your editorial statement that therapy should probably be promptly instituted rather than waiting several days (201:877, 1967).The rationale for prompt use of anticoagulants is based primarily on the study of Carter,1 in which he reported a significantly higher recovery rate in those patients who were promptly treated. Subsequent reports by other investigators were less enthusiastic however, and Carter himself has modified his earlier approach, delaying anticoagulants for three weeks.2Neuropathologists are familiar with the frequent occurrence of hemorrhagic infarction following cerebral embolism, as shown both in experimental animals and at autopsy. Fisher and Adams3 reported a 51% incidence of hemorrhagic infarction in 123 cases of fatal cerebral embolism. They demonstrated fragmentation of