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Use of anticoagulant in
prevention of stroke |
| Atrial fibrillation |
 | For patients with atrial fibrillation, Warfarin reduces stroke by 68% |
| Annual stroke rate reduced from 4.5% to 1.4%
per year |
| There is a tendency for cardioembolic stroke to undergo hemorrhagic
transformation |
| Best time to start Warfarin after stroke is not clear |
| For large stroke, consider delay anticoagulation for 2 days to 2 weeks |
| Except: high risk cardiac lesion, such as
 | mechanical heart valve |
| established intracardiac thrombus |
| atrial fibrillation w mitral stenosis or congestive heart failure |
|
| Aim for INR between 2 and 3 |
| Patients under 60 year old with lone atrial fibrillation without other stroke
risk factor do not need Warfarin |
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| Treatment Guideline |
| The recommendations are primarily based on
| patient age |
| presence or absence of a history of cardiovascular risk factors
 | TIA/stroke, hypertension, heart failure, diabetes mellitus, clinical coronary artery disease, echocardiographic findings of left atrial enlargement or left ventricular
dysfunction |
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| In the absence of a medical contraindication to
anticoagulation
| Age > 75 years: warfarin |
| Age 65 - 75 years with risk factor: warfarin; |
| Age 65 - 75 years without risk factor: warfarin or
aspirin |
| Age < 65 years with risk factor: warfarin |
| Age < 65 years without risk factor: aspirin or observe. |
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| Side effect of Warfarin treatment |
| Risk of intracranial hemorrhage (pooled analysis)
| 0.3% vs 0.1% per year in control group |
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| Risk of intracranial hemorrhage for patient >75 year old
| 1.8% per year |
| Risk of hemorrhage may increase with INR > 3
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| Further Reading |
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