Related Experiment Video

Updated: Jul 3, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

Anticoagulation after cardioembolic stroke: to bridge or not to bridge?

Hen Hallevi1, Karen C Albright, Sheryl Martin-Schild

  • 1Department of Neurology, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 7.044, Houston, TX 77030, USA. hen.hallevi@uth.tmc.edu

Archives of Neurology
|July 16, 2008
PubMed

Insights

For cardioembolic stroke patients, starting warfarin soon after the event is safe. However, heparin or enoxaparin bridging therapies increase the risk of serious bleeding complications.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Cardioembolic stroke necessitates long-term anticoagulation for most patients.
  • Optimal timing and methods for initiating anticoagulation remain unclear.
  • This study reviews patients with cardioembolic stroke not treated with tissue plasminogen activator.

Purpose of the Study:

  • To compare the safety and efficacy of different anticoagulation strategies in patients with cardioembolic stroke.
  • To evaluate risks of hemorrhagic transformation, stroke progression, and bleeding associated with various anticoagulation regimens.

Main Methods:

  • Retrospective review of 204 patients with cardioembolic stroke.
  • Patients were grouped by treatment: no treatment, aspirin only, aspirin then warfarin, heparin bridging, or enoxaparin bridging.
  • Outcomes included symptomatic hemorrhagic transformation, stroke progression, and modified Rankin Scale score.

Main Results:

  • Recurrent stroke occurred in 1% of patients; progressive stroke in 5%.
  • Symptomatic hemorrhagic transformation was exclusively observed in the enoxaparin bridging group (10%, P = .003).
  • Systemic bleeding occurred in 1% of patients, associated with heparin bridging (P = .04).

Conclusions:

  • Initiating warfarin shortly after cardioembolic stroke is a safe anticoagulation strategy.
  • Heparin bridging and enoxaparin bridging regimens are associated with an increased risk of serious bleeding.
  • Warfarin monotherapy or aspirin may be preferred for initial anticoagulation in selected patients.
Abstract

Related Concept Videos

Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors01:20

Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors

Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...