Abstract
Since preventive therapies for cerebral ischemia hasn't fully been established, safe control of anticoagulant and antithrombotic treatments was investigated. In patients of cerebral ischemia, hyperactivity of blood coagulation or platelet aggregation is frequently encountered. If it can be suppressed or controled in normal level, second attack of cerebral infarction might be prevented. Anticoagulant therapy was performed to 40 cases of cerebral ischemia. For maintaining the value of thrombo-test in a range between 10 to 20%, the best administrative method of Warfarin without hazard is considered as follow : Day 1, 15 mg, Warfarin p.o.; Day 2, 12 mg; Day 3, no administration; From Day 4, 3 mg, daily as maintenance dose. Mean dosage of Warfarin was 4.7 mg/day. The thrombo-test should be carried out every day during the treatment for detecting hemorrhagic tendency. By this therapeutic procedure, second attack of cerebral infarction was completely prevented without hemorrhage.
In case of antithrombotic therapy without measurement of platelet aggregation activity, a case of subarachnoid, intracerebral hemorrhage and 4 gastric bleedings were encountered. Hemorrhage was, however, completely prevented in cases under control by platelet aggregation test.
For maintaining in suitable range of platelet aggregation activity of patients, Aspirin adminiation should be adjusted to obtain the activity in a range between a normal level (the second aggregation occurred by a final concentration of 3 μM ADP), and slightly suppressed level (5 μM ADP). In 68.6% of the cases, 200 mg/day of Ticlopidine hydrochloride was enough to obtain desirable clinical effect. 300 mg/day of the drug was rarely needed.
Under therapeutic procedure, second attack of cerebral infarction was completely prevented without hemorrhage. Anticoagulant and antithrombotic agents can be safely administered under careful measurement of both thrombo-test and platelet aggregation activity. Those therapeutic procedures are valuable and recommended for preventing second attack of cerebral ischemia.
