Stroke: Insights into Thromboembolism Treatment and Prevention through the Decades
05 March 2019
11 March 2019
04 April 2019 (eFirst)
With the availability of back issues online for Thrombosis & Haemostasis ever since the original first published issue in 1957 (then under the name Thrombosis et Diasthesis Haemorrhagica), we felt that stroke could be an initial special focus, given the publication on this topic in Volume 1, Issue 1 of this journal.
Way back in 1957, the era that ‘the treatment for all cerebral vascular diseases was futile’ and ‘the physician's choice lay between masterly inactivity and skilful neglect ’, was slowly giving its place to a period of progress in stroke prevention and treatment. At that time, physicians were beginning to feel optimistic that they had started climbing up the learning curve, although it was still clear that they ‘did not consider present treatment entirely satisfactory’.
Let's take a hypothetical patient, Michael, in the 1950s. If only Michael could share his optimism this evening. For the last 2 hours, he was lying on a bed in the emergency department of the hospital waiting for a physician to examine him and help him talk and move his right leg and hand again. It was easy for him to guess that he was having a “brain attack”—many of his friends had suffered something similar, and many of them did not make it through. Next day, although dizzy, Michael could listen to the doctor talking to his daughter:
‘We took some fluid from his spinal cord for examination and we tend to conclude that this is probably a non-haemorrhagic infarction (1). We don’t really know why it happened, for most of our patients we don't. I won't fool you, the management of this entity is discouragingly inadequate. We tried all our weapons: we blocked his stellate ganglion to increase the collateral vessels around the dead zone, we administered intravenous procaine and histamine , carbon dioxide , nicotine and whiskey, ephedrine and ritalin , cortisol, we tried everything… I am sorry, no improvement'.
‘Will you do an arteriogram to my father, doctor?’, she asked.
‘Will you treat him with anticoagulants, doctor?’, she asked again looking desperately for a glimpse of hope.
‘No’, he said avoiding looking her in the eyes. ‘We are rather reluctant with this form of treatment. In our own hospital we have been impressed by the dangers of using anticoagulants in the severely hypertensive patient and by the incidence of haemorrhagic problems that occur when long-term anticoagulation is undertaken. It certainly should not be considered a benign procedure but rather one which presents definite risks’.
The doctor proved to be right: Michael did not make it through, and he never made it to see Helena, his fourth grandchild, to be born a few weeks later.
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