Anticoagulant-related hemorrhage in acute cerebral embolism.

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Abstract
Five patients with nonseptic cerebral embolism of cardiac origin are reported in whom early anticoagulant therapy resulted in clinical deterioration or death from frank hemorrhage into the acute infarct. In each patient an initial CT [computed tomography] scan excluded the presence of intracerebral hemorrhage and a 2nd CT scan, after clinical deterioration had occurred, documented frank hemorrhage into the infarcted zone. All 5 patients had large infarctions in the right middle cerebral artery territory and 3 patients were mildly hypertensive. Four patients received heparin within 36 h of their stroke and 1 was on warfarin at time of the embolism. Clinical deterioration occurred after intervals of several h (2 cases), 5-6 days (2 cases) and 30 days (1 case). In only 2 patients was anticoagulant activity excessive at time of clinical deterioration. The danger of early anticoagulant therapy of acute nonseptic cerbral embolism, particularly in the setting of large infarction is illustrated.