Anticoagulation Timing in Cardioembolic Stroke and Recurrent Event Risk

To me it seems vastly more important to get more oxygen to your brain to prevent more neurons dying. Like maybe these. I don't consider HBOT an option, too expensive and not easily obtained.  

Possible solutions: Obviously not vetted coming from me. Don't do them. 

Normobaric oxygen (10)

How to Improve Your Brain Function with An Oxygen Concentrator April 2018 

Or is it more important to increase the loading ability of red blood cells to carry more oxygen? 

Like this?

University of Glasgow Study Demonstrates the Ability of Oxycyte® to Supply Oxygen to Critical Penumbral Tissue in Acute Ischemic Stroke  August 2012

Or like this?

chronic cannabis users have higher cerebral blood flow and extract more oxygen from brain blood flow than nonusers. August 2017  

The latest here:

Anticoagulation Timing in Cardioembolic Stroke and Recurrent Event Risk

Shadi Yaghi MD

Tushar Trivedi MD MPH

Dr med Nils Henninger MD PhD

James Giles MD

Angela Liu MD

Muhammad Nagy MD

Ashutosh Kaushal MD

Idrees Azher MD

… See all authors

First published: 12 July 2020

https://doi.org/10.1002/ana.25844

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ana.25844.

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Abstract

Objectives

Guidelines recommend to initiate anticoagulation within 4‐14 days after cardioembolic stroke. Data supporting this did not account for key factors potentially affecting the decision to initiate anticoagulation such as infarct size, hemorrhagic transformation, or high risk features on echocardiography.

Methods

We pooled data from stroke registries of 8 comprehensive stroke centers across the United States. We included consecutive patients admitted with ischemic stroke and atrial fibrillation. The primary predictor was timing of initiating anticoagulation (0‐3 days, 4‐14 days, or >14 days) and outcomes were recurrent stroke/TIA/systemic embolism, symptomatic intracerebral hemorrhage (sICH), and major extracranial hemorrhage (ECH) within 90 days.

Results

Among 2084 patients, 1289 met the inclusion criteria. The combined endpoint occurred in 10.1% (n = 130) subjects (87 ischemic events, 20 sICH, and 29 ECH). Overall, there was no significant difference in the composite endpoint between the three groups: 0‐3 days [10.3% (64/617)], 4‐14 days [(9.7%) 52/535)], >14 days [10.2% (14/137), p=0.933]. In adjusted models, patients started on anticoagulation between 4‐14 days did not have a lower rate of sICH (vs. 0‐3 days) (OR 1.49 95% CI 0.50 – 4.43) neither did they have a lower rate of recurrent ischemic events (vs. > 14 days) (OR 0.76 95% CI 0.36 – 1.62, p = 0.482).

Interpretation

In this multicenter real world cohort, the recommended (4‐14 days) time frame to start oral anticoagulation was not associated with reduced ischemic and hemorrhagic outcomes. Randomized trials are required to determine the optimal timing of anticoagulation initiation.
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