When is anticoagulation indicated after acute ischemic stroke?

Updated: Dec 18, 2018
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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The role of anticoagulation in the treatment of cerebral ischemia has changed. For many years, it was used routinely in acute ischemic stroke. However, more current studies are helping to refine its role in the acute treatment and prevention of stroke. In addition, several new oral and parenteral anticoagulants are in different stages of clinical trials for use in the prophylaxis of ischemic thromboembolic stroke.

Anticoagulation for acute ischemic stroke

Current data do not support routine use of anticoagulation for acute ischemic stroke. However, anticoagulation continues to be recommended for some specific clinical situations. Indications currently proposed by many experts for early full-dose IV heparin after stroke or transient ischemic attack (TIA) include the following:

  • Conditions with potential high risk of early cardiogenic reembolization

  • Symptomatic dissection of the arteries supplying the brain

  • Symptomatic extracranial or intracranial arteriosclerotic stenosis with crescendo TIAs or early progressive stroke

  • Basilar artery occlusion before or after intra-arterial pharmacological or mechanical thrombolysis.

  • Known hypercoagulable states

  • Cerebral venous sinus thrombosis

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