chapter  10
15 Pages

Stroke prevention-oral anticoagulants

WithThierry Moulin, Fabrice Vuillier, Laurent Tatu

In the older population, the principal causes of death and disability are frequently represented by ischemic strokes. Patients with stroke are at risk for recurrence, myocardial infarction, and more generally, vascular death, corresponding to 10. 7% by 1 year (Sacco et al., 1989). In addition, stroke recurrence is also important to consider for subsequent cognitive or physical dysfunctions. While a good control of arterial blood pressure, decreased cigarette smoking, and modified dietary habits are among classic targets for stroke prevention, antithrombotic therapy also appears to have a major impact. The use of antithrombotic therapy when rigorously prescribed may prevent stroke recurrence (Barnett et al., 1995). Ischemic stroke can be caused by several major disorders leading to occlusion of cerebral arteries such as cardioembolism, largeartery disease or micro-angiopathy. The efficacy of antithrombotic prophylaxis in each of these major stroke subtypes is likely to be different and it is possible to choose an alternative and effective treatment in each subtype of stroke. Although anticoagulation is quite well established as being effective for the prevention of cardiogenic brain embolism, its value has not been totally proven for patients with other cerebrovascular diseases, and antiplatelet agents are more frequently used.