Diagnosis:
- Ischemic stroke with cardiac source found on investigations.
Treatment:
No use for anticoagulation if not cardioembolic [TOAST]
Choice of anticoagulant:
- Apixaban
- Dabigatran
- Warfarin orally, goal INR= 3.0-4.0 monitor every 2 weeks. Start Warfarin therapy without bridging [retrospective review]
- Other options: edoxaban, rivaroxaban
Anticoagulate if:
- Atrial fibrillation [EAFT]
- Prosthetic valve: If recurrent on anticoagulation add Aspirin 100mg P.O.
- <3 months post MI
- Some patients with dilated cardiomyopathy
In acute phase without thrombolysis:
- In Atrial fibrillation: No difference between aspirin & dalteparin. [HAEST]
- In unselected stroke group: No difference in efficacy between Aspirin & tinzaparin, more symptomatic intracranial hemorrhages with tinzaparin up to 14 days. [TAIST]
Related articles:
References:
- Secondary prevention in non-rheumatic atrial fibrillation after transient ischemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet, 1993. 342(8882): p. 1255-62.
- Berge, E., et al., Low molecular-weight heparin versus aspirin in patients with acute ischemic stroke and atrial fibrillation: a double-blind randomised study. HAEST Study Group. Heparin in Acute Embolic Stroke Trial. Lancet, 2000. 355(9211): p. 1205-10.
- Wallmann, D., et al., Frequent atrial premature beats predict paroxysmal atrial fibrillation in stroke patients: an opportunity for a new diagnostic strategy. Stroke, 2007. 38(8): p. 2292-4.
- Hallevi, H., et al., Anticoagulation After Cardioembolic Stroke: To Bridge or Not to Bridge? Arch Neurol, 2008.