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The title suggests that anticoagulation may no longer have a role in the treatment of atherothrombotic cerebrovascular disease.While evidence from recent studies has not shown a distinct benefit of anticoagulation following acute stroke,the designs of these studies may not have distinguished important differences in stroke types adequately.Before judging anticoagulation,we will review the pathogenesis of atherothrombotic stroke and consider the historical role of anticoagulation in its treatment by analyzing early and recent treatment trials.Although questions remain about timing and duration of treatment, the effectiveness of anticoagulation in preventing recurrent cardiac source cerebral embolism has generally been accepted and therefore will not be discussed.The use of anticoagulants in atherothrombotic cerebrovascular disease is based on their ability to interfere with thrombus formation.Thrombosis superimposed on vessels narrowed by atherosclerotic plaque is a critical feature of the atherosclerotic process.Inhibition of thrombosis allows continued blood flow in the primary vessels causing ischemia,as well as in vessels arising from the parent trunk threatened by obstruction from advancing clot.This may provide time for the formation of important collateral blood channels to ameliorate the ischemic process. |
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