Cardioembolic Stroke

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:

  1. 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.
  2. 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.
  3. 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.
  4. Hallevi, H., et al., Anticoagulation After Cardioembolic Stroke: To Bridge or Not to Bridge? Arch Neurol, 2008.