Thrombi of Different Pathologies: Implications for Diagnosis and Treatment

Abstract

Stroke is the second leading cause of cardiovascular mortality in the modern world, accounting for 80% of strokes of ischemic origin. There are two main etiologies of ischemic stroke: 70% to 80% are caused by carotid atherosclerotic plaque rupture and superimposed thrombus formation, whereas 30% are caused by systemic embolism of a cardiac thrombus (mainly in atrial fibrillation [AF] patients). Therefore, antithrombotic therapy is the cornerstone of stroke treatment. In AF patients, thrombotic risk should be assessed by means of the CHADS2 score. Patients with a score of 0 should be treated with aspirin; for those with a score of 1, oral anticoagulation (target international normalized ratio, 2-3) or aspirin is recommended. For patients with a CHADS2 score ≥2, oral anticoagulation with warfarin should be initiated (unless contraindicated). If warfarin is contraindicated, antithrombotic treatment should be prescribed (the combination of aspirin and clopidogrel seems to be superior to aspirin alone). For primary prevention in atherosclerotic patients, low-dose aspirin is useful only in women older than 45 years who are not at risk for intracranial hemorrhage and do not have gastrointestinal intolerance (a very small but significant effect). For secondary prevention in atherosclerotic patients, antithrombotic therapy should be administered. It is recommended that patients who do not require anticoagulation receive clopidogrel or a combination of aspirin and dipyridamole. Alternatively, aspirin alone or triflusal may be used. Within 4.5 h of onset of acute stroke, thrombolytic therapy (recombinant tissue plasminogen activator) must be injected urgently (unless contraindicated). Dabigatran is a new oral anticoagulant (competitive thrombin inhibitor) with a promising role in stroke prevention; at low doses, it is noninferior to warfarin for stroke prevention and is safer, whereas at high doses, it is superior to warfarin in stroke prevention with the same incidence of bleeding. Percutaneous left atrial appendage occluders recently were approved for systemic embolism prevention. The use of warfarin after implantation is still under discussion. Dronedarone, a new antiarrhythmic agent, has been shown to decrease cardiovascular mortality and stroke in patients with AF. Carotid endarterectomy surgery is indicated in symptomatic patients with stenosis greater than 70% and in selected patients with 50% to 70% stenosis. Currently, carotid endarterectomy surgery is superior to carotid angioplasty and stenting.

The effect of in-hospital acquired thrombocytopenia on the outcome of patients with acute coronary syndromes: A systematic review and meta-analysis

“…1–3 Indeed, platelet physiology is causally involved in ACS of not only atherosclerotic but also non-atherosclerotic origin, such in the case of community-acquired pneumonia-related ACS. 4,5 As such, antiplatelet therapy is of critical importance in cardiovascular disease.…”

Increase in the Size of an Intracardiac Thrombus during Dabigatran Therapy (110 mg b.i.d.) in an Acute Cardioembolic Stroke Patient

“…An intracardiac thrombus is detected by TEE in 12-14% of patients with NVAF [2,3,4]. The decrease in the size of a thrombus that occurs after warfarin therapy may be due to the relative predominance of plasma fibrinolytic activity over anticoagulation-inhibited thrombin activity [1].…”

Anticoagulation in the Surgical Management of Peripheral Arterial Embolic Disease

“…Patients suffering with strokes are a similar group of patients and clear guidance regarding secondary prevention has been formulated [14,17]. It has been recognised that further research into patients with arterial embolic disease is needed [6].…”

“…In the peri-operative period options for anticoagulation include unfractionated heparin (UFH) and low molecular weight heparin (LMWH). There is currently good evidence to support the use of LMWH over UFH in thromboembolic conditions such as deep venous thromboembolism and acute coronary syndrome [8][9][10][11][12][13][14]. LMWH has now replaced the use of UFH in these conditions due to a lower complication rate [9].…”