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 Printable version |
The risk of cerebral infarction |
Sang Thrombose Vaisseaux. Volume 10, Number 6, 351-9, Juin 1998, Mini-revues
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 Résumé
Article gratuit
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Author(s) : Caroline Arquizan |
Summary : Ischaemic strokes are a major complication of myocardial infarction and aggravate the prognosis. During the acute phase, the risk is estimated to be about 2% (with perhaps a slight decrease in the incidence over the last few years). The long-term risk is not well known and seems relatively low, about 3% at 3 years. The factors which predispose to ischeamic stroke are variable: classical vascular risk factors (age…), factors related to the infarct itself (left ventricular thrombus…) and factors detected by complementary investigations. During the acute phase, the principal mechanism is embolic (especially in cases of left ventricular thrombosis), but, at long-term, the mechanism is not clearcut and the responsability of certain abnormalities such as akinetic left ventricular segments remains to be proved. In some cases, the mechanism is not apparent, and it must be remembered that the diagnosis of a cardio-embolic ischaemic stroke cannot be made in the presence of another cause, which should be searched for and which may be associated.
Randomised large scale therapeutic trials have investigated the value of different therapies for management of the risk of cerebral embolism. During the acute phase, the benefits of thrombolytics and anticoagulants have not been clearly established but platelet antiaggregant therapy decreases the risk of ischaemic stroke by 50 %. In the long-term after myocardial infarction, anticoagulants and antiagregants reduce the risk by about 40%, and the superiority of one of these therapeutic agents or of their association remains to be demonstated. Finally, the statins have recently been the subject of much comment: two randomised large scale trials have shown a 30% decrease in the risk of ischaemic stroke in patients treated with statins. |
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