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July 1985

Cere bral Emboli of Cardiac Origin

Author Affiliations

San Antonio, Tex

Arch Intern Med. 1985;145(7):1329. doi:10.1001/archinte.1985.00360070211039

To the Editor.  —Martin and Biller1 anticoa gulated 59 consecutive patients with presumed cardiogenic brain embolism, and no patient experienced brain hemorrhage. This experience contrasts markedly with the recent reports of secondary brain hemorrhage in 14%2 and 16%3 of consecutive anticoagulated patients who had suffered embolic strokes. This striking discrepancy in rates of hemorrhagic complications suggests that either differences in the patient population (eg, infarct size) or anticoagulation practice (eg, timing of initiation of anticoagulation) were operative. It has been suggested that infarct size and interval from stroke onset to initial, nonhemorrhagic computed tomography (CT) may predict risk of brain hemorrhage in this setting.4,5 Would Drs Martin and Biller provide further information on estimated infarct size (percentage with large infarcts) and interval from stroke onset to initial CT (mean interval, percentage less than 24 hours)? While we fully agree with their conclusions and recommendations, additional information