How is stroke prevented in patients with basilar artery thrombosis?

Updated: Jan 11, 2019
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Prevention strategies for basilar artery thrombosis, in addition to risk factor control, depend pharmacologically on the cause of the occlusion. For example, patients with a definite cardioembolic source, such as atrial fibrillation, should be treated with warfarin to maintain an INR of between 2 and 3, or with a novel anticoagulant such as dabigatran, rivaroxaban or apixaban.

For patients with atherosclerotic stenosis who survive basilar artery occlusion, the estimated annual risk of recurrent stroke is 20%. Antiplatelet agents such as aspirin, clopidogrel, and the combination aspirin/dipyridamole (Aggrenox) can be used for stroke prophylaxis.  Secondary prevention trials showed that these agents are marginally better than aspirin alone; therefore, they may be the drugs of choice.

Long-term anticoagulation with warfarin was advocated as the treatment of choice, but the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group demonstrated that warfarin is no better than aspirin in preventing strokes in patients with intracranial artery stenosis and is associated with bleeding complications.

No definite indication currently exists for long-term anticoagulation in patients with noncardioembolic stroke.


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