Therapeutic dilemma: When to start anticoagulation for cardiac thrombi in acute ischemic stroke? Lessons from cases

Abstract

Ischemic stroke has been one of the major reason for morbidity and mortality all over the world. Anticoagulation treatment in patients with cerebral ischemic events caused by cardiac emboli is no longer a matter of debate. The problem is when to start. Because of a recurrence rate of 15 to 20% in the first few weeks after the initial event, direct anticoagulation by means of intravenous heparin followed by oral anticoagulants seems to be indicated. We are presenting 2 cases of patients who suffered cardio-embolic stroke due to cardiac thrombosis and had a therapeutic dilemma on when to start the anticoagulation treatment. Early anticoagulation treatment was associated with good clinical and neurological outcome. Keywords: anticoagulation; stroke; cardiac thrombus; cardio-embolic stroke; hemorrhagic stroke; warfarin.