Current Treatment Options in Neurology

, Volume 4, Issue 6, pp 411–416

Long-term anticoagulation therapy in prevention of stroke

  • David Sherman
Article

Opinion statement

Long-term anticoagulation continues to be used and investigated as a means to prevent new or recurrent stroke. The best-established indications for long-term anticoagulation are cardiac abnormalities capable of producing intracardiac thrombi that may embolize into the brain or systemic circulation. The firmest cardiac indications are mechanical prosthetic heart valves, mitral stenosis with atrial fibrillation, and atrial fibrillation with additional features placing them at increased risk for stroke. These and other “major” cardiac potential sources of emboli should be considered as anticoagulation candidates unless the estimated risk of bleeding is prohibitive. A number of noncardiac potential causes of stroke are generally managed with long-term anticoagulation. These include arterial dissections, cerebral venous sinus thrombosis, the antiphospholipid antibody syndrome, and congenital and acquired coagulopathies. Recent randomized studies do not support the use of long-term anticoagulation for the prevention of recurrent stroke in patients with noncardioembolic stroke that is not due to the previously outlined disorders. Whether long-term anticoagulation is beneficial in the specific population of patients with major documented intracranial atherosclerotic stenosis is currently under investigation.

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References and Recommended Reading

  1. 1.
    Falk RH: Atrial fibrillation. N Engl J Med 2001, 344:1067–1078. An excellent review of atrial fibrillation management.PubMedCrossRefGoogle Scholar
  2. 2.
    Albers GW: Choice of antithrombotic therapy for stroke prevention in atrial fibrillation: warfarin, aspirin, or both? Arch Intern Med 1998, 158:1487–1491.PubMedCrossRefGoogle Scholar
  3. 3.
    Albers GW, Dalen JE, Laupacis A, et al.: Antithrombotic therapy in atrial fibrillation. Chest 2001, 119(suppl):194S-206S. Review of clinical trials and recommendations for management of atrial fibrillation.PubMedCrossRefGoogle Scholar
  4. 4.
    Salem DN, Daudelin HD, Levine HJ, et al.: Antithrombotic therapy in valvular heart disease. Chest 2001, 119(suppl):207S-219S.PubMedCrossRefGoogle Scholar
  5. 5.
    Stein PD, Alpert JS, Bussey HI, et al.: Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest 2001, 119(suppl):220S-227S. An excellent review and consensus statement.PubMedCrossRefGoogle Scholar
  6. 6.
    Mas JL, Arquizan C, Lamy C, et al.: Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 2001, 345:1740–1746.PubMedCrossRefGoogle Scholar
  7. 7.
    Mohr JP, Thompson JLP, Lazar RM, et al.: A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001, 345:1444–1451. Report of this large randomized trial.PubMedCrossRefGoogle Scholar
  8. 8.
    Homma S, Sacco RL, DiTullio MR, et al.: PICSS-PFO in cryptogenic stroke study. Circulation 2002, 105:2625–2631.PubMedCrossRefGoogle Scholar
  9. 9.
    Amarenco P, Cohen A, Tzourio C, et al.: Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 1994, 331:1474–1479.PubMedCrossRefGoogle Scholar
  10. 10.
    Cohen A, Tzourio C, Bertrand B, et al.: Aortic plaque morphology and vascular events: a follow-up study in patients with ischemic stroke. FAPS investigators: French study of aortic plaques in stroke. Circulation 1997, 96:3838–3841.PubMedGoogle Scholar
  11. 11.
    Cairns JA, Theroux P, Lewis HD, et al.: Antithrombotic agents in coronary artery disease. Chest 2001, 119(suppl):228S-252S. An excellent review and consensus statement.PubMedCrossRefGoogle Scholar
  12. 12.
    Albers G, Amarenco P, Easton JD, et al.: Antithrombotic and thrombolytic therapy for ischemic stroke. Chest 2001, 119(suppl):300S-320S. An excellent review and consensus statement.PubMedCrossRefGoogle Scholar
  13. 13.
    Khamashta MA, Cuadrado MJ, Mujic F, et al.: The management of thrombosis in the antiphospholipidantibody syndrome. N Engl J Med 1995, 332:993–997.PubMedCrossRefGoogle Scholar
  14. 14.
    Brey R: Preliminary concordance between antiphospholipid (aPL) assays in a subset of ischemic stroke patients enrolled in the WARSS/APASS collaboration. Stroke 2002, In press.Google Scholar
  15. 15.
    Levine MN, Raskob G, Landefeld S, Kearon C: Hemorrhagic complications of anticoagulant treatment. Chest 2001, 119(suppl):108S-121S. An excellent review and consensus statement.PubMedCrossRefGoogle Scholar
  16. 16.
    Hirsh J, Dalen JE, Anderson DR, et al.: Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 2001, 119:8–21. An excellent review and consensus statement.CrossRefGoogle Scholar
  17. 17.
    Ansell J, Hirsh J, Dalen J, et al.: Managing oral anticoagulant therapy. Chest 2001, 119(suppl):22S-38S. An excellent review and consensus statement.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • David Sherman
    • 1
  1. 1.Division of Neurology, Department of MedicineThe University of Texas Health Science CenterSan AntonioUSA

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