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Department of Neurology (Stroke Service), Tufts University School of Medicine, New England Medical Center and Spaulding Rehabilitation Hospital, Boston, MA.
Cerebral hemorrhagic infarction visualized on CT, secondary to embolic stroke in an anticoagulat-ed individual, is usually associated with clinically stable or improving neurologic signs; fear of transforming the hemorrhagic infarction into a hematoma, however, usually prompts cessation of anticoagulation until the blood has cleared on CT, despite the recognized risk of recurrent embolism during this non-anticoagulated period. We now report our experience with 12 patients with hemorrhagic infarction who remained anticoagulated. Eleven men and one woman, ages 33 to 77, developed hemorrhagic infarction while on heparin, warfarin, or both, for prevention of recurrent embolism. Patients were either continued on uninterrupted anticoagulation from stroke onset (n = 6), or anticoagulation was withheld for several days and then resumed (n = 4), or it was withheld for 5 and 14 days (n = 2) after stroke onset and then continued uninterrupted despite the CT appearance of hemorrhagic infarction. Eleven patients had a definite cardioembolic source for stroke (atrial fibrillation, seven; ventricular thrombus, two; and ventricular dyskinesia, two). One patient had carotid occlusion with local intra-arterial embolism. Hemorrhagic infarcts varied in size and were located in the middle cerebral artery territory in 11 patients and posterior cerebral artery territory in one. All patients remained clinically stable or improved on anticoagulation. Serial CTs showed fading hemorrhagic areas. When the risk of recurrent embolism is high, anticoagulation may be safely used in some patients with hemorrhagic infarction.
Presented in part at the 43rd annual meeting of the American Academy of Neurology, Boston, MA, April 1991.
Address correspondence and reprint requests to Dr. Michael Pessin, Department of Neurology, New England Medical Center, 750 Washington Street, Boston, MA 02111.
Received December 8, 1992. Accepted for publication in final form March 29, 1993.
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