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Anticoagulation and Stroke
Gisela Tinone1, Mauricio Hoshino1, Leandro Lucato2
1Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo, SP, Brazil.
Arquivos De Neuro-Psiquiatria
|August 17, 2022
Summary
Anticoagulation is not routinely recommended for acute ischemic stroke but has specific uses. Restarting anticoagulation after stroke, especially with bleeding, requires careful timing, often delayed weeks to months.
Area of Science:
- Neurology
- Cardiology
- Hematology
Background:
- The 2019 American Heart Association guidelines do not support emergent anticoagulation for acute ischemic stroke.
- Specific clinical scenarios warrant a re-evaluation of anticoagulation's role in ischemic stroke management.
- Understanding indications and contraindications for anticoagulation is crucial for patient outcomes.
Purpose of the Study:
- To analyze the indications for anticoagulation in specific acute ischemic stroke cases.
- To discuss secondary prevention strategies using anticoagulation.
- To address the challenges in timing anticoagulation restart after stroke or hemorrhagic transformation.
Main Methods:
- Review of current guidelines and clinical evidence regarding anticoagulation in ischemic stroke.
- Analysis of specific patient populations requiring anticoagulation.
- Discussion of factors influencing the decision to restart anticoagulation post-stroke.
Main Results:
- Anticoagulation may be indicated for ischemic stroke due to extracranial artery thrombus with artery-to-artery embolization.
- Indications include stroke from cervical artery dissection, catastrophic antiphospholipid syndrome (APS), and certain COVID-19 cases.
- Secondary prevention with anticoagulation is recommended for cardioembolic stroke, cervical artery dissection, cancer-associated stroke, and thrombophilia (e.g., APS).
Conclusions:
- Anticoagulation has defined roles in specific acute ischemic stroke scenarios and for secondary prevention.
- Restarting anticoagulation after stroke, particularly with hemorrhagic transformation, necessitates a delayed approach (minimum 2 weeks, ideally 4 weeks) due to high thromboembolic risk.
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