Cardiac Embolic Stroke: Anticoagulating the Elderly

  • Stanford Wessler


Stroke remains the third commonest cause of death in the United States. Cerebral infarcts from cardiac emboli represent a progressively increasing percentage of strokes. as non-traumatic cerebral hemorrhages secondary to hypertension continue to decline. In no age group is this increase in cerebral infarction from cardiac emboli more apparent than in the elderly. 75 per cent of individuals over age 85 are not in nursing homes;1 yet an increasing number of these individuals remain at risk of premature death or disability from an embolic stroke.


Atrial Fibrillation Cerebral Hemorrhage Infarcted Area Rheumatic Heart Disease Cerebral Embolism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Population estimates and projections. U.S. Dept. Commerce, Bureau of the Census Series P-25 #965(1985).Google Scholar
  2. 2.
    M. L. Dyker, P. A. Wolf, H. J. M. Barnett, et al: Risk factors in stroke. A statement for physicians by the subcommittee on risk factors and stroke of the stroke council. Stroke 15:1105(1984).Google Scholar
  3. 4.
    Cerebral Embolism Task Force: Cardiogenic brain embolism. Arch Neurol 43:71(1986).CrossRefGoogle Scholar
  4. 4.
    Cerebral Embolism Task Force: Cardiogenic brain embolism. Arch Neurol 43:71(1986).CrossRefGoogle Scholar
  5. 5.
    P. A. Wolf, W. Kannel, D. L. McGee, et al: Duration of atrial fibrillation and imminence of stroke: The Framingham Study. Stroke 14: 664(1983).PubMedCrossRefGoogle Scholar
  6. 6.
    A. Torvik, L, Jorgensen: Thrombotic and embolic occlusions of the carotid arteries in an autopsy material. Part I, Prevalence, location and associated diseases. J Neurol Sci 1:24(1964).CrossRefGoogle Scholar
  7. 7.
    I. Starkey, C. Warlow: The secondary prevention of stroke in patients with atrial fibrillation. Arch Neurol 43:66(1986).PubMedCrossRefGoogle Scholar
  8. 8.
    S. Butler: The Note-books of Samuel Butler, London, A C Fifield, p 11(1912).Google Scholar
  9. 9.
    A. J. Moss: Atrial fibrillation and cerebral embolism. Arch Neurol 41:707(1984).PubMedCrossRefGoogle Scholar
  10. 10.
    J. Sage, R. Van Uitert: Risk of recurrent stroke in patients with atrial fibrillation and non-valvular heart disease. Stroke 14:537(1983).PubMedCrossRefGoogle Scholar
  11. 11.
    J. K. Campbell, O. W. Houser, J. C. Stevens, H. W. Wahner, H. L. Baker, W. N. Folger: Computed tomography and radionuclide imaging in the evaluation of ischemic stroke. Radiology 126:702(1978).Google Scholar
  12. 12.
    I. Feigen, G. W. Budzilovich: The general pathology of cerebrovascular disease. In: Handbook of Clinical Neurology vol 11, Vinken P.J. Bruyn G. W. eds. North Holland Publishing Co. Amsterdam, pp 128(1972).Google Scholar
  13. 13.
    A. M. Hakim, A. Ryder-Cooke, D. Melanson: Sequential computerized tomographic appearance of strokes. Stroke 14:893(1983).PubMedCrossRefGoogle Scholar
  14. 14.
    M. Fisher, R. D. Adams: Observations on brain embolism with special reference to the mechanism of hemorrhagic infarction. J Neuropathol Exp Neurol 10:92(1950).Google Scholar
  15. 15.
    F. Khaja, J. A. Walton Jr., J. F. Brymer, et al. Intracoronary fibrinolytic therapy in acute myocardial infarction. Report of a prospective randomized trial. N Engl J Med 308:1305(1983).PubMedCrossRefGoogle Scholar
  16. 16.
    K. P. Rentrop, F. Feit, H. Blanke, et al. Effects of intracoronary Streptokinase and intracoronary nitroglycerin infustion on coronary angiographic patterns and mortality in patients with acute myocardial infarction. N Engl J Med 311:1457(1984).PubMedCrossRefGoogle Scholar
  17. 17.
    S. Wessler, Is anticoagulant prophylaxis of cardiac emboli practical? Geriatrics (in press).Google Scholar
  18. 18.
    Health and Public Policy Committee, American College of Physicians. The diagnostic spinal tap. Ann Int Med 104:880(1986).CrossRefGoogle Scholar
  19. 19.
    H. M. Marin, M. Stefanini: Experimental production of phlebothrombosis. Surg Gynec Obst 110:263(1960).Google Scholar
  20. 20.
    S. Wessler: Thrombosis in the presence of vascular stasis. Am J Med 33:648(1962).PubMedCrossRefGoogle Scholar
  21. 21.
    C. R. Hornig, W. Dorndorf, A. L. Agnoli: Hemorrhagic cerebral infarction—a prospective study. Stroke 17:179(1986).PubMedCrossRefGoogle Scholar
  22. 22.
    C. P. Warlow, D. Ogston, A. S. Douglas: Deep venous thrombosis of the legs after strokes. Part I. Incidence and predisposing factors. Lancet 1:1178(1976).Google Scholar
  23. 23.
    A. T. Miyamoto, L. S. Miller: Pulmonary embolism in stroke: prevention by early heparinization of venous thrombosis detected by iodine-125 fibrinogen leg scans. Arch Phys Med Rehab 61:584(1980).Google Scholar
  24. 24.
    National Safety Council Accident Facts, p 83 (1985).Google Scholar
  25. 25.
    S. R. Cummings, J. L. Kelsey, M. C. Nevitt, K. J. O’Dowd. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 7:178(1985).PubMedGoogle Scholar
  26. 26.
    M. E. Tinetti, T. F. Williams, R. Mayewski: Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 80:429 (1986).PubMedCrossRefGoogle Scholar
  27. 27.
    D. Allen: Falls—big worry for the elderly. Family Safety 38:23(1979).Google Scholar
  28. 28.
    M. Peszczynski: Why people fall. Am J Nursing 65:86(1965).Google Scholar
  29. 29.
    R. A. Nishimura, M. D. McGoon, C. Shub, et al. Echocardiographically documented mitral-valve prolapse. Long-term follow-up of 237 patients. N Engl J Med 313:1305(1985).PubMedCrossRefGoogle Scholar
  30. 30.
    R. Hull, T. Delmore, C. Carter, et al: Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis. N Engl J Med 306:189(1982).PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1987

Authors and Affiliations

  • Stanford Wessler
    • 1
  1. 1.Department of MedicineNew York University School of MedicineNew YorkUSA

Personalised recommendations