Antithrombotic therapy for primary and seconda- ry prevention of Ischemic Cardioembolic CVA - Points of Interest in the Therapeutic Guidelines

Cerebral vascular accident (CVA) is the leading cause of death in Portugal, and as such, deserves our attention in terms of preventive care and therapy. The goal of this review is to explain the antithrombotic options to be considered in patients at risk of a cardioembolic event. The methodology used in the review process consisted of a detailed analysis of a set of papers, clinical trials and reviews, obtained through research on Medline and Google, taking in the last fifteen years of research in the field of CVA. Determining the ischemic pathogenesis of CVA, although difficult, is extremely important, as it is decisive in guiding the therapy. In thromboembolic CVA, the most frequent focus is the heart and the first step in determining the pathogenesis is to acknowledge the embolic potential of the baseline cardiopathy. Atrial fibrillation (AF) is the most frequent major risk for embolic cardiopathy. For primary prevention, patients with AF and one or more high risk factors should be treated with oral anticoagulants, and patients with low risk should be treated with antiplatelet drugs. In patients with moderate risk, the choice of therapy should consider factors such as the patient’s preferences, individual bleeding risk, and the possibility of effectively monitoring the oral anticoagulant therapy. For secondary prevention, the decision regarding preventive care to be adopted should continue to be based on the most likely cause of cerebral infarction.