• transoesophageal echocardiography
• stroke

In a recent article in this journal, Strandberg et al reported 441 patients who were investigated by transoesophageal echocardiography (TOE) after ischaemic stroke or transient ischaemic attacks.¹ The authors looked for cardiac sources of embolism. They found that in patients who were in sinus rhythm and without any cardiac disease, 8% have been given anticoagulation drugs on the basis of TOE data.

Although we agree with their conclusions that TOE should be used in patients with stroke we have, however, concerns about the following points:

• No definition is given of what is meant by “anticoagulation drugs.” Did the authors mean only oral anticoagulation with acenocoumarol or phenprocoumon, or did they also mean other antithrombotic drugs like heparin, acetylsalicylic acid, or clopidogrel?

• What contraindications to anticoagulant drugs did they consider?

• How long after the stroke or transient ischaemic attack was anticoagulant treatment started?

• The decision about anticoagulation was based on “clinical assessment.” They report that “if a minor risk factor for a cardiac source of embolism was detected, anticoagulation treatment was started after clinical consideration of the …