Antithrombotic Therapy For The Acute Non-large Area Cardiogenic Cerebral Embolism

Background:Cardiac cerebral embolism (CCE) is an important kind of ischaemic stroke, which is caused by the emboli coming from the endocardium and valve. The Embolus can block the arteries in the brain. Cardiogenic cerebral embolism is characterized by the rapid clinical onset, the heavy neurological damage, a quickly reached peak and high morbidity and mortality. The complications of cardiogenic cerebral embolism include Heart failure, Arrhythmia, Lung infection and so on. Cardiogenic cerebral embolism have a high rate of hemorrhagic transformation, which can increase the neurological damages and prolong the patient’s hospital stay and recovery time. Currently we do not have the standardized treatment guidelines to guide the acute treatment of cardiogenic cerebral embolism in our country.Objective:To compare the efficacy and tolerability between the anticoagulant therapy and antiplatelet therapy which are used in the non-large area acute cardiogenic cerebral embolism with nonvalvular atrial fibrillation.Method:A multicenter stratified randomized single-blind controlled trial was performed. Patients were randomized to low-molecular-weight-heparin group (treatment group) and aspirin group (control group). NIHSS were assessed on day0, day7and day21.BI score and mRS scores were assessed3months after discharge.Results:The treatment group in Antithrombotic treatment (n=47) showed a significant greater improvement on the primary outcome than the control group (n=47) in the antiplatelet treatment by comparing of absolute change value of NIHSS scores between two groups on day7,day14,and of the percent change of NIHSS scores on day7,day14,day21.Meanwhile, there was more effective in resolving the nervous function and reliving the disable degree in the treatment group than in the control grow3months after discharging.Conclusion:Anticoagulant therapy for the acute non-large area acute cardiogenic cerebral embolism with nonvalvular atrial fibrillation showed a better primary outcome and neural functional recovery. There was also no difference in hemorrhagic stokes in either group.