[Indications for anticoagulant use in secondary prevention of strokes]

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Oral anticoagulants have shown significant efficacy in secondary stroke prevention over the past two decades.
• The effectiveness of these agents is highly dependent on the underlying cause of the stroke, dictating specific indications.

Purpose of the Study:

• To delineate the established, non-demonstrated, and potential indications for oral anticoagulant therapy in secondary stroke prevention.
• To critically evaluate the evidence supporting current and emerging uses of oral anticoagulants in cerebrovascular disease.

Main Methods:

• Review of clinical evidence and established guidelines for oral anticoagulant use in secondary stroke prevention.
• Analysis of indications based on the etiological classification of ischemic stroke.

Main Results:

• Atrial fibrillation and mechanical prosthetic valves are the only well-demonstrated indications for oral anticoagulants in secondary stroke prevention.
• Dissection of cervical arteries, aortal atheroma, and antiphospholipid antibody syndrome are admitted but not demonstrated indications.
• Potential indications include intracranial artery stenosis, patent foramen ovale with atrial septum aneurysm, and basilar artery dolichoectasia.

Conclusions:

• Current evidence strongly supports oral anticoagulants for specific etiologies of ischemic stroke, primarily atrial fibrillation and mechanical valves.
• Further rigorous clinical trials are necessary to establish efficacy for other potential indications and to clarify their role in complex cerebrovascular conditions.