Early Recurrent Embolism Rheumatic Heart Disease

To the Editor.  —The issue of when to initiate anticoagulation following embolic stroke remains controversial. The retrospective study of Calandre et al¹ contributes valuable data in this regard. However, several additional, pertinent studies have appeared since preparation of their article,^2-7 prompting further questions about their data and conclusions.The authors concluded that "early recurrent embolic events are not frequent after embolic strokes secondary to RHD [rheumatic heart disease]" and, based on their 17 nonanticoagulated patients, "several patients were being treated with platelet-inhibiting drugs, which in some way could help against cerebral embolism."¹ This conclusion seems premature because of the small numbers in their study, and it conflicts with several other studies (Table). The authors postulated that these studies, carried out before computed tomographic (CT) scans were performed, misdiagnosed hemorrhagic transformation with worsening as early recurrent embolism. However, this seems unlikely to entirely explain the higher rates of