Deans' stroke musings: Update of Anticoagulation Use in Cardioembolic Stroke With a Special Reference to Endovascular Treatment

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, April 9, 2024

Update of Anticoagulation Use in Cardioembolic Stroke With a Special Reference to Endovascular Treatment

Obviously(at least to me) we need further research in predicting and preventing the problems here. But with NO leadership in stroke, NOTHING WILL GET DONE!

Update of Anticoagulation Use in Cardioembolic Stroke With a Special Reference to Endovascular Treatment

Apostolos Safouris^1,^2,³, Klearchos Psychogios¹, Lina Palaiodimou², Peter Orosz³, George Magoufis^4,⁵, Odysseas Kargiotis¹, Aikaterini Theodorou², Theodore Karapanayiotides⁶, Stavros Spiliopoulos⁵, Sándor Nardai³, Amrou Sarraj⁷, Thanh N. Nguyen⁸, Shadi Yaghi⁹, Silke Walter¹⁰, Simona Sacco¹¹, Guillaume Turc^12,^13,^14,¹⁵, Georgios Tsivgoulis^2,¹⁶

¹Stroke Unit, Metropolitan Hospital, Piraeus, Greece

²Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

³Department of Neurointerventions, National Institute of Mental Health, Neurology and Neurosurgery, Semmelweis University, Department of Neurosurgery, Budapest, Hungary

⁴Interventional Neuroradiology Unit, Metropolitan Hospital, Piraeus, Greece

⁵Second Department of Radiology, Interventional Radiology Unit, “Attikon” University Hospital, Athens, Greece

⁶Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece

⁷Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

⁸Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA

⁹Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA

¹⁰Department of Neurology, Saarland University Medical Centre, Homburg, Germany

¹¹Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy

¹²Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France

¹³INSERM U1266, Paris, France

¹⁴FHU Neurovasc, Paris, France

¹⁵Université Paris Cité, Paris, France

¹⁶Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA

Correspondence: Dr. Georgios Tsivgoulis Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, Chaidari, Athens, Greece 12462 Tel: +30-6937178635 Email: tsivgoulisgiorg@yahoo.gr

Received May 15, 2023 Revised November 30, 2023 Accepted December 4, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cardioembolic stroke is a major cause of morbidity, with a high risk of recurrence, and anticoagulation represents the mainstay of secondary stroke prevention in most patients. The implementation of endovascular treatment in routine clinical practice complicates the decision to initiate anticoagulation, especially in patients with early hemorrhagic transformation who are considered at higher risk of hematoma expansion. Late hemorrhagic transformation in the days and weeks following stroke remains a potentially serious complication for which we still do not have any established clinical or radiological prediction tools. The optimal time to initiate therapy is challenging to define since delaying effective secondary prevention treatment exposes patients to the risk of recurrent embolism. Consequently, there is clinical equipoise to define and individualize the optimal timepoint to initiate anticoagulation combining the lowest risk of hemorrhagic transformation and ischemic recurrence in cardioembolic stroke patients. In this narrative review, we will highlight and critically outline recent observational and randomized relevant evidence in different subtypes of cardioembolic stroke with a special focus on anticoagulation initiation following endovascular treatment. We will refer mainly to the commonest cause of cardioembolism, non-valvular atrial fibrillation, and examine the possible risk and benefit of anticoagulation before, during, and shortly after the acute phase of stroke. Other indications of anticoagulation after ischemic stroke will be briefly discussed. We provide a synthesis of available data to help clinicians individualize the timing of initiation of oral anticoagulation based on the presence and extent of hemorrhagic transformation as well as stroke severity.