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March 1984

Conversion of Ischemic to Hemorrhagic Infarction by Anticoagulant Administration

Author Affiliations

Director of Cerebrovascular Program Department of Neurology Cleveland Clinic Foundation 9500 Euclid Ave Cleveland, OH 44106

Arch Neurol. 1984;41(3):248. doi:10.1001/archneur.1984.04050150026004

To the Editor.  —The safety and efficacy of immediate anticoagulant therapy following nonseptic embolic brain infarction remains controversial.1 My group2 and Koller3 recently published data suggesting that immediate heparin sodium therapy appears to reduce the risk of early embolic recurrence, without a significant risk of intracranial bleeding, in carefully selected patients. Since then, a number of patients have been called to my attention who appeared to hemorrhage into a bland embolic infarct while receiving heparin therapy.At first glance, the two patients described by Drake and Shin1 seemed to illustrate this complication. However, both of them may have actually undergone the natural evolution of a massive hemorrhagic infarction, shown by computed tomography (CT), rather than a complication of anticoagulant therapy. The time course for the evolution of hemorrhagic infarction shown by CT is unclear. I am aware of a few patients with embolic infarcts and an

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