Streifler J Y, Katz M
Neurology Unit, Hasharon Hospital, Golda Medical Center, Petah-Tiqva, Tel Aviv, Israel.
Curr Opin Neurol. 1995 Feb;8(1):45-54. doi: 10.1097/00019052-199502000-00008.
New technology has made it possible to identify cardiogenic cerebral emboli more easily and reliably. In recent years echocardiography, and in particular transesophageal echocardiography, has become the gold standard for the identification of cardiogenic sources of emboli, whereas transcranial Doppler is an important technique for the detection of cerebral emboli. Treatment strategies are better established and more accurate, if more complex, since the completion of large randomized trials. For primary prevention of stroke in elderly patients with nonvalvular atrial fibrillation, warfarin is generally indicated, yet in patients aged 60-75 years with no risk factors, aspirin may be sufficient. Warfarin is hazardous in older high-risk patients even at the 'low intensity' of the anticoagulation regimen; even lower doses are therefore being tested. Heparin and aspirin are indicated for short-term treatment of acute myocardial infarction, whereas for long-term treatment aspirin is still the drug of choice. However, if mobile left ventricular thrombi are present, warfarin is superior and new studies have shown its effectiveness for all myocardial infarction survivors. Combined treatment of warfarin and aspirin appears to be most effective in patients with mechanical prosthetic valves.
新技术使得更轻松、可靠地识别心源性脑栓塞成为可能。近年来，超声心动图，尤其是经食管超声心动图，已成为识别心源性栓子来源的金标准，而经颅多普勒是检测脑栓塞的一项重要技术。自大型随机试验完成以来，治疗策略虽更复杂但已得到更好的确立且更为准确。对于老年非瓣膜性心房颤动患者的卒中一级预防，通常使用华法林，然而对于无危险因素的60 - 75岁患者，阿司匹林可能就足够了。华法林在老年高危患者中即使采用“低强度”抗凝方案也有风险；因此正在测试更低的剂量。肝素和阿司匹林用于急性心肌梗死的短期治疗，而长期治疗时阿司匹林仍是首选药物。然而，如果存在活动的左心室血栓，华法林更具优势，并且新的研究已表明其对所有心肌梗死幸存者均有效。华法林和阿司匹林联合治疗在机械人工瓣膜患者中似乎最为有效。
