ABC of Antithrombotic by Edited by Andrew D. Blann Edited by Gregory Y. H. Lip

By Edited by Andrew D. Blann Edited by Gregory Y. H. Lip

Urban health facility, Birmingham, united kingdom. Discusses the factors and results of blood clots, how antithrombotic remedy works and its makes use of for sufferers. Addresses bleeding dangers, venous thromboembolism, atrial traumatic inflammation, peripheral vascular affliction, center failure, and anticoagulation. plentiful halftone and colour illustrations. Softcover.

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Larger doses have no apparent additional benefit but increase the risk of adverse effects. Aspirin has been shown to reduce the progression of atherosclerosis in a few trials, but this remains unsubstantiated. The role of dipyridamole remains controversial. Several small studies have shown the benefit of giving it in conjunction with aspirin, but it is uncertain if dipyridamole alone is superior to aspirin. In aspirin intolerant patients there is now a clear role for clopidogrel 75 mg once a day.

Although no randomised trials have specifically addressed the issue, there is evidence that cardioversion may be safely performed without anticoagulation if the arrhythmia has been present for < 48 hours. However, in one series intra-atrial thrombus was detected by transoesophageal echocardiography in about 15% of patients presenting with acute atrial fibrillation (apparent duration < 48 hours), raising the possibility that the development of intra-atrial thrombus may be faster than previously suspected, or that in many apparent cases of acute atrial fibrillation the arrhythmia developed asymptomatically > 48 hours before.

Atherosclerosis of the major cerebral vessels probably accounts for most ischaemic strokes, either as thrombotic occlusion at the site of atherosclerotic plaques or atherogenic embolism. Embolism from a source in the heart (cardioembolic stroke) and lipohyalinosis of the penetrating small cerebral vessels (lacunar stroke) account for a substantial proportion of ischaemic strokes. In many patients the aetiology remains unknown. The major risk factors for ischaemic stroke include old age, male sex, obesity, hypertension, diabetes, and tobacco smoking.

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