—We thank Drs Hart and Bogousslavsky for their valuable comments. Regarding Dr Hart's comments we should emphasize that our statement about the low frequency of recurrent emboli was meant for the first three days (in which risk of hemorrhagic transformation is highest). We have studied all the patients admitted with cerebral embolism secondary to RHD since our first series was concluded. There were 19 patients. In ten patients anticoagulants were administered after 48 to 72 hours, and no recurrent embolic events occurred in this short period before treatment. However, in one case a systemic embolism occurred 24 hours prior to the cerebral embolic event. We were surprised by the frequency of hemorrhagic transformation in our first series, but not by the fact that such an event correlated with clinical worsening. There is evidence1 that hemorrhagic transformation in anticoagulated patients (quite similar to spontaneous transformation) is often accompanied by neurologic
Calandre L, Ortega JF, Gomora S, Bermejo F. Anticoagulation and Bleeding Into Embolic Infarcts-Reply. Arch Neurol. 1985;42(11):1034–1035. doi:10.1001/archneur.1985.04060100012003
Monkeypox Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.