Update of Anticoagulation Use in Cardioembolic Stroke With a Special Reference to Endovascular Treatment

Area of Science:

• Neurology
• Cardiology
• Vascular Medicine

Background:

• Cardioembolic stroke necessitates anticoagulation for secondary prevention.
• Endovascular treatment complicates anticoagulation timing due to hemorrhagic transformation risks.
• Optimal anticoagulation initiation post-stroke remains undefined, balancing recurrence and bleeding.

Purpose of the Study:

• To review evidence on anticoagulation timing after cardioembolic stroke.
• To focus on anticoagulation post-endovascular treatment and hemorrhagic transformation.
• To aid clinicians in individualizing anticoagulation initiation.

Main Methods:

• Narrative review of observational and randomized studies.
• Focus on non-valvular atrial fibrillation as a cause of cardioembolism.
• Analysis of risks and benefits of anticoagulation at different time points.

Main Results:

• Early hemorrhagic transformation increases hematoma expansion risk.
• Late hemorrhagic transformation lacks prediction tools.
• Delayed anticoagulation increases recurrent embolism risk.

Conclusions:

• Individualizing anticoagulation timing is crucial for cardioembolic stroke patients.
• Balancing ischemic recurrence and hemorrhagic transformation is key.
• Clinical and radiological factors should guide anticoagulation initiation.