BACKGROUND: Recurrent thrombo-embolism represents by far the commonest cause of cerebral and retinal ischaemia. In an open clinical study, experience with a largely general anticoagulation in the acute phase of cerebral and retinal ischaemia is reported. METHODS: From October 1993 to October 1996, 781 patients with acute cerebral ischaemia were admitted to the medical emergency ward. Taking contra-indications into consideration and after CT exclusion of cerebral haemorrhage (2%). Immediate therapeutic heparinisation (1.5-2-fold prolongation of aPTT) was administered to 664 patients (85%) over 7-10 days. In a concurrent Doppler/duplex comparative study, 143 patients with retinal artery occlusion were investigated for the prevalence of potential sources of emboli in the region of the extracranial carotids and internal carotid circulation respectively. 108 patients served as a reference group whose acute loss of vision of vascular origin could be attributed to retinal vein thrombosis. RESULTS: The complication rate of anticoagulation in acute cerebral ischaemia was 0.8% (major complications), and the recurrence rate during the period of treatment was 2.4%. In 131 patients with acute retinal ischaemia, therapeutic heparinisation was performed without ocular cerebral or extracerebral complications. Potential ipsilateral sources of emboli (highgrade carotid stenosis or complex plaques with thrombotic deposits) were found in 55%, but in only 7% of the control group (p < 0.0001). CONCLUSION: Immediate anticoagulation in the form of aPTT-monitored therapeutic heparinisation represents a rational and low-risk concept for the treatment of acute cerebral and retinal ischaemia.
BACKGROUND: Recurrent thrombo-embolism represents by far the commonest cause of cerebral and retinal ischaemia. In an open clinical study, experience with a largely general anticoagulation in the acute phase of cerebral and retinal ischaemia is reported. METHODS: From October 1993 to October 1996, 781 patients with acute cerebral ischaemia were admitted to the medical emergency ward. Taking contra-indications into consideration and after CT exclusion of cerebral haemorrhage (2%). Immediate therapeutic heparinisation (1.5-2-fold prolongation of aPTT) was administered to 664 patients (85%) over 7-10 days. In a concurrent Doppler/duplex comparative study, 143 patients with retinal artery occlusion were investigated for the prevalence of potential sources of emboli in the region of the extracranial carotids and internal carotid circulation respectively. 108 patients served as a reference group whose acute loss of vision of vascular origin could be attributed to retinal vein thrombosis. RESULTS: The complication rate of anticoagulation in acute cerebral ischaemia was 0.8% (major complications), and the recurrence rate during the period of treatment was 2.4%. In 131 patients with acute retinal ischaemia, therapeutic heparinisation was performed without ocular cerebral or extracerebral complications. Potential ipsilateral sources of emboli (highgrade carotid stenosis or complex plaques with thrombotic deposits) were found in 55%, but in only 7% of the control group (p < 0.0001). CONCLUSION: Immediate anticoagulation in the form of aPTT-monitored therapeutic heparinisation represents a rational and low-risk concept for the treatment of acute cerebral and retinal ischaemia.