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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Difficult situations in anticoagulation after stroke: between Scylla and Charybdis
George Ntaios1, Gregory Y H Lip
1aDepartment of Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece bUniversity of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom cAalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Current Opinion in Neurology
|December 8, 2015
Summary
Managing anticoagulation in stroke patients requires balancing bleeding and clotting risks. This review discusses key decisions for secondary stroke prevention, emphasizing individualized patient care.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Anticoagulants are crucial for secondary stroke prevention in many patients.
- Balancing thromboembolic risk and bleeding risk presents significant clinical challenges.
- Stroke physicians frequently encounter complex anticoagulant-related decisions.
Purpose of the Study:
- To address three common clinical scenarios involving anticoagulation in stroke patients.
- To guide decision-making in balancing bleeding and thromboembolic risks.
- To review current literature and evidence for managing these situations.
Main Methods:
- Discussion of three representative case vignettes.
- Summary and synthesis of relevant medical literature.
- Analysis of pros and cons for different management strategies.
Main Results:
- Case 1: Restarting anticoagulation after anticoagulant-related intracranial hemorrhage.
- Case 2: Perioperative anticoagulation management for elective procedures in anticoagulated patients with atrial fibrillation.
- Case 3: Timing of anticoagulation initiation after an ischemic stroke in patients with atrial fibrillation.
Conclusions:
- Limited evidence necessitates individualized patient management.
- Shared decision-making with patients and proxies is essential.
- Patient values and preferences must be strongly considered in treatment plans.
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