From the Guidelines
Recent Ischemic Stroke is not an absolute contraindication to anticoagulation, as anticoagulation can be indicated for secondary prevention in patients with atrial fibrillation and a history of ischemic stroke, as long as there are no other contraindications to anticoagulation. According to the most recent and highest quality study, 1, anticoagulation is recommended for secondary prevention in patients with atrial fibrillation and a history of ischemic stroke, without contraindications. The optimal timing of anticoagulation early after acute ischemic stroke is unknown, but early use of non-vitamin K antagonist oral anticoagulants (NOACs) shows promise.
Some key points to consider when evaluating contraindications to anticoagulation include:
- Active bleeding, severe thrombocytopenia, recent major surgery, hemorrhagic stroke, and severe uncontrolled hypertension are generally considered contraindications to anticoagulation.
- Recent ischemic stroke, on the other hand, may not be an absolute contraindication, especially in patients with atrial fibrillation, as the benefits of anticoagulation for secondary prevention may outweigh the risks.
- The decision to anticoagulate always requires individualized risk assessment, considering both thrombotic and hemorrhagic risks for each patient, as well as regular reassessment of the risk-benefit profile throughout treatment.
It's also important to note that the guidelines and recommendations may vary depending on the specific clinical context and patient population, and clinicians should consult the most up-to-date and relevant guidelines when making decisions about anticoagulation therapy, such as those from 1 and 1.
From the Research
Contraindications to Anticoagulation
The following are contraindications to anticoagulation:
- Recent Hemorrhagic Stroke
- Active bleed into a critical site
- Recent Traumatic Surgery
Not a Contraindication to Anticoagulation
The following is not a contraindication to anticoagulation:
- Recent Ischemic Stroke, as anticoagulation may be initiated or resumed after a certain period for secondary stroke prevention, as indicated by studies 2, 3
Key Points
- Anticoagulation is crucial in preventing stroke in patients with atrial fibrillation, and the timing of initiation or resumption of anticoagulation after an acute ischemic stroke must be carefully considered 2
- Direct oral anticoagulants (DOACs) such as apixaban, dabigatran, and rivaroxaban are effective and safe alternatives to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation 3, 4, 5
- The risk of hemorrhagic conversion must be balanced against the benefits of anticoagulation in patients with a history of ischemic stroke 2