Cerebrovascular Disease - Results With Antithrombotic Therapy : Some Observations

Antithrombotic therapy is now widely used in the treatment of patients with ischemic cerebrovascular disease. Governmental approval will increase use and further convince many that the issues of therapy are now resolved. They are not. The following approved professional labelling guidelines serve to highlight the many clinical and investigational problems that remain: (1) There is evidence that aspirin is safe and effective for reducing the risk of stroke in men who have symptoms due to fibrin-platelet emboli.(2) Patients should have a complete medical and neurologic evaluation.(3) The recommended dosage is 1300 mgm/day.The evidence for effectiveness, while of statistical significance, becomes clinically less important when one notes that in the Canadian study, a disturbing 12.4% of patients under treatment with aspirin, developed subsequent stroke. This should not be unexpected since similar cerebral ischemic symptoms may be produced by differing pathophysiologic mechanisms (not all related to fibrin-platelet embolization); and treatment for one may be illogical and ineffective for another. Accurate diagnosis is imperative for selecting appropriate therapy. In the clinical situation, in spite of “complete” evaluation, uncertainty of the underlying mechanism often remains. Questions also remain about the dosage recommendations, and other treatment alternatives for both women and men.Subsequent clinical trials will need to consider each of the above. Until then, patients with cerebral ischemic symptoms must be evaluated individually. Some may benefit from antithrombotic therapy-many will not.