Ten rules for oral anticoagulants prescription after a stroke

Abstract

Every third or fourth ischemic stroke is cardioembolic. Prescribing oral anticoagulants can significantly reduce the risk of recurrent stroke, but this strategy requires the physician to have a firm orientation in the “efficacy – safety” coordinate system. We formulate 10 rules that should help any interested specialist (neurologist, cardiologist, therapist) to decide on the prescription of oral anticoagulants for cardioembolic stroke in daily clinical practice. We discuss issues of selection of an anticoagulant in atrial fibrillation, mitral stenosis and mechanical heart valves, the timing of prescription (also in haemorrhagic transformation of ischemic stroke and after intracerebral hemorrhage), the special features of anticoagulant prophylaxis in comorbid and “fragile” patients are discussed, the development of a stroke while taking an anticoagulant, the timing of discontinuation and resumption of therapy during surgical interventions, the choice of dose and peculiarities of therapy in cognitively impaired patients.

Keywords

• cardioembolic stroke
• oral anticoagulants
• apixaban