Antithrombotic therapy for primary and secondary prevention of Cardioembolic Ischemic Cerebral Infarction – interests in therapeutic orientation

Abstract

Stroke is one of the principal causes of death in Portugal as such
it deserves all our attention in terms of preventive medicine and
treatment. This revision aims to explain the antithrombotic options
to take in patients with cardio embolic pathogenesis. The methodology used in the process of revision was a detailed analysis of
a set of articles obtained by inquiry Medline and Google, clinic
trails and revisions, including the last 15 years of investigation in
the stroke area. In spite of being difficult to establish the pathogenesis of an ischemic cerebral infarction, his determination is of
extreme importance once that it is determinative of the therapeutic
direction. The more frequent embolic focus is the heart and the
first step in the determination of the potential pathogenesis is
the recognition of the embolic potential of the cardiopathy. Atrial
fibrillation is the more frequent major risk cardiopathy. In primary
prevention, patients with one or more high risk factors must be
treated with oral anticoagulant and patients with low risk must be
treated by anti-platelets drugs. In patients with moderated risk the
therapeutic choice depends on the preferences of the patient, the
individual haemorrhagic risk and the possibility of the efficiently
control of the anticoagulant therapy. On secondary prevention the
decision must be based in the most probable cause of cerebral
infarction, so the subtype of cerebral infarction has an important
role in the choice of the secondary preventive therapy.