Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack

Abstract

Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack.

Use of Heparin in Acute Ischemic Stroke: Is There Still a Role?

“…These results have been confirmed by subsequent trials [6][7][8] and in the 2009 Cochrane review which evaluated 11 trials with over 2000 patients showing that acute anticoagulation for ischemic stroke patients leads to 11 additional fatal intracranial hemorrhages per year for every 1000 patients given with anticoagulant therapy [9]. Hence, for allcomers with AIS, while anticoagulation may reduce recurrent ischemic stroke and improve short-term outcome, this benefit is outweighed by the risk of hemorrhagic transformation and does not translate into improved long-term functional outcome.…”

Use of Heparin in Acute Ischemic Stroke: Is There Still a Role?

“…These results have been confirmed by subsequent trials [6][7][8] and in the 2009 Cochrane review which evaluated 11 trials with over 2000 patients showing that acute anticoagulation for ischemic stroke patients leads to 11 additional fatal intracranial hemorrhages per year for every 1000 patients given with anticoagulant therapy [9]. Hence, for allcomers with AIS, while anticoagulation may reduce recurrent ischemic stroke and improve short-term outcome, this benefit is outweighed by the risk of hemorrhagic transformation and does not translate into improved long-term functional outcome.…”

Spontaneous coronary thrombosis following thrombolytic therapy for acute cardiovascular accident and stroke: a case study

“…Despite molecular mechanisms supporting the same prothrombic state as the coronary population, clinical data suggests only a mild cardiovascular improvement without mortality benefit [19,20]. Substantially higher bleeding rates (especially intracerebral hemorrhage, which can be nearly 15 times higher in individuals on warfarin [Coumadin]), make the risk of anticoagulation unacceptably high and limits clinical utility [21,22]. Thus, full anticoagulation remains an AHA Class III recommendation for at least 24 hours following t-PA administration [7].…”

Platelet aggregation inhibitors, vitamin K antagonists and risk of subarachnoid hemorrhage

“…Of note is that the beneficial effects of well‐indicated antithrombotic drugs in appropriate patients should not be disregarded. However, any benefits could be offset by an increased risk of hemorrhages [24]. This may be the case in subgroups of high‐risk patients, for instance patients harboring an unruptered intracranial aneurysm, In those patients caution might be warranted with regard to prescribing vitamin K antagonists.…”

Use of Heparin in Acute Ischemic Stroke: Is There Still a Role?

“…These results have been confirmed by subsequent trials [6][7][8] and in the 2009 Cochrane review which evaluated 11 trials with over 2000 patients showing that acute anticoagulation for ischemic stroke patients leads to 11 additional fatal intracranial hemorrhages per year for every 1000 patients given with anticoagulant therapy [9]. Hence, for allcomers with AIS, while anticoagulation may reduce recurrent ischemic stroke and improve short-term outcome, this benefit is outweighed by the risk of hemorrhagic transformation and does not translate into improved long-term functional outcome.…”

Spontaneous coronary thrombosis following thrombolytic therapy for acute cardiovascular accident and stroke: a case study

“…Despite molecular mechanisms supporting the same prothrombic state as the coronary population, clinical data suggests only a mild cardiovascular improvement without mortality benefit [19,20]. Substantially higher bleeding rates (especially intracerebral hemorrhage, which can be nearly 15 times higher in individuals on warfarin [Coumadin]), make the risk of anticoagulation unacceptably high and limits clinical utility [21,22]. Thus, full anticoagulation remains an AHA Class III recommendation for at least 24 hours following t-PA administration [7].…”

Platelet aggregation inhibitors, vitamin K antagonists and risk of subarachnoid hemorrhage

“…Of note is that the beneficial effects of well‐indicated antithrombotic drugs in appropriate patients should not be disregarded. However, any benefits could be offset by an increased risk of hemorrhages [24]. This may be the case in subgroups of high‐risk patients, for instance patients harboring an unruptered intracranial aneurysm, In those patients caution might be warranted with regard to prescribing vitamin K antagonists.…”

Use of Heparin in Acute Ischemic Stroke: Is There Still a Role?

“…These results have been confirmed by subsequent trials [6][7][8] and in the 2009 Cochrane review which evaluated 11 trials with over 2000 patients showing that acute anticoagulation for ischemic stroke patients leads to 11 additional fatal intracranial hemorrhages per year for every 1000 patients given with anticoagulant therapy [9]. Hence, for allcomers with AIS, while anticoagulation may reduce recurrent ischemic stroke and improve short-term outcome, this benefit is outweighed by the risk of hemorrhagic transformation and does not translate into improved long-term functional outcome.…”

Spontaneous coronary thrombosis following thrombolytic therapy for acute cardiovascular accident and stroke: a case study

“…Despite molecular mechanisms supporting the same prothrombic state as the coronary population, clinical data suggests only a mild cardiovascular improvement without mortality benefit [19,20]. Substantially higher bleeding rates (especially intracerebral hemorrhage, which can be nearly 15 times higher in individuals on warfarin [Coumadin]), make the risk of anticoagulation unacceptably high and limits clinical utility [21,22]. Thus, full anticoagulation remains an AHA Class III recommendation for at least 24 hours following t-PA administration [7].…”

Platelet aggregation inhibitors, vitamin K antagonists and risk of subarachnoid hemorrhage

“…Of note is that the beneficial effects of well‐indicated antithrombotic drugs in appropriate patients should not be disregarded. However, any benefits could be offset by an increased risk of hemorrhages [24]. This may be the case in subgroups of high‐risk patients, for instance patients harboring an unruptered intracranial aneurysm, In those patients caution might be warranted with regard to prescribing vitamin K antagonists.…”