Anticoagulation and Stroke

Abstract In 2019, the American Heart Association did not recommend the emergent use of anticoagulation to prevent recurrence or progression of acute ischemic stroke. However, its indication in patients with extracranial artery intraluminal thrombus with artery-to-artery cerebral embolization must be analyzed. In this article, we will also discuss other indications of anticoagulation. This treatment could be indicated in patients with ischemic stroke caused by embolization from cervical artery dissection, catastrophic antiphospholipid antibodies syndrome (APS) and some cases of Covid 19. For secondary prevention, anticoagulation is recommended for Cardioembolic stroke such as nonvalvular atrial fibrillation and other cardiopathies, some patients with cervical artery dissection, stroke associated with cancer, and thrombophilia such as APS. The timing to restart anticoagulation after a large ischemic stroke or after a cerebral hemorrhagic transformation always represent a challenge. Even in patients with high risk of thromboembolism it should be delayed at least two weeks, ideal after four weeks.

摘要：2019年，美国心脏协会（American Heart Association）未推荐紧急使用抗凝治疗（anticoagulation）以预防急性缺血性脑卒中（acute ischemic stroke）的复发或病情进展。但针对伴有动脉-动脉脑栓塞（artery-to-artery cerebral embolization）的颅外动脉腔内血栓（extracranial artery intraluminal thrombus）患者，其抗凝治疗的适应证仍需进一步分析。本文还将探讨抗凝治疗的其他适用指征。该治疗方案可应用于由颈动脉夹层（cervical artery dissection）、灾难性抗磷脂抗体综合征（catastrophic antiphospholipid antibodies syndrome, APS）以及部分新冠（Covid 19）病例的栓塞所引发的缺血性脑卒中患者。在二级预防中，抗凝治疗被推荐用于心源性脑卒中（Cardioembolic stroke）患者，例如非瓣膜性心房颤动（nonvalvular atrial fibrillation）及其他心脏疾病患者、部分颈动脉夹层患者、癌相关脑卒中患者，以及如APS这类易栓症（thrombophilia）患者。对于发生大面积缺血性脑卒中或出现出血性脑转化（cerebral hemorrhagic transformation）的患者，重启抗凝治疗的时机始终是一项临床难题。即便患者存在高血栓栓塞风险，重启抗凝治疗也至少应延迟两周，理想情况下应在四周后进行。