Stroke – cardiogenic emboli

Posted On May 3, 2020

Anticoagulation recommended for

  • atrial fibrillation, atrial flutter
  • MI with mural thrombus
  • Mechanical cardiac valve
  • PFO with evidence of deep vein thrombosis
  • Hypercoagulable state, warfarin is indicated for
    • Antiphospholipid syndrome
    • Inherited thrombophilia

Anticoagulation can be considered

  • Dilated cardiomyopathy, EF < 35%
  • Restrictive cardiomyopathy
  • Acute STEMI without mural thrombus but with anterior of apical dyskinesia with EF < 40%

Anticoagulation plus aspirin reasonable for

  • atrial fibrillation plus unstable coronary artery disease or stent
  • mechanical valve with stroke
  • Bioprosthetic valve with stroke despite adequate antiplatelet

When to start anticoagulation after a stroke

  • Diener Law
    • tia: immediate
    • Mild stroke (nihss < 8): 3 to 5 days
    • Moderate stroke (nihss 8-16): 5-7 days
    • Severe stroke (nihss over 16): 2 weeks
  • Stroke with hemorrhagic transformation
    • mild to moderate stroke, NIHSS < 9
      • restart at 14 days