Treatment of cerebrovascular disease with anticoagulants and platelet anti-aggregants

Introduction. The use of anticoagulants and platelet anti-aggregants is one of the basic features of the management of patients with cerebrovascular disease. Development. The indications for the use of these agents have evolved from initial empirical use based on anecdotic evidence to current recommendations following multi-centre trials. Aspirin, ticlopidine, clopidogrel and warfarin are drugs of choice for secondary prevention of ischemic stroke (IS). Anticoagulants are used more inpatients with IS of cardio-embolic origin. The use of anti-aggregants/anticoagulation in acute IS has not been shown to be clearly effective and its use is limited to particular cases in which fibrinolytic treatment cannot be used. For satisfactory use of these drugs it is essential to correctly identify the type of IS and its progress over time. This article reviews the criteria established for the use of such treatment and describes the developing areas of multi-centre clinical trials [REV NEUROL 1999; 29: 1285-90].