Key result
Prompt rt-PA within 3 hours for acute cardioembolic stroke, while immediate anticoagulation requires individualized risk assessment.
Why the study?
The efficacy and optimal timing of immediate anticoagulant therapy in the acute phase of cardioembolic stroke remain uncertain.
Supports cautious anticoagulation decisions in acute cardioembolic stroke; leaves open optimal timing from higher-level evidence.
In addition to the general treatment, rt-PA intravenous thrombolysis, intraarterial thrombolysis, brain protecting therapy with edaravone, glycerol treatment against brain edema, and immediate anticoagulant therapy should be considered in acute phase of cardioembolic stroke. The rt-PA intravenous thrombolysis within three hours of onset is recommended in acute stroke patients who meet criteria for the therapy. Because the efficacy of immediate anticoagulation in acute cardioembolic stroke has not been established yet, it depends on balance of risk and benefit in each patient whether immediate anticoagulant therapy should be commenced or not. When we start anticoagulation with warfarin, heparin which has rapid action should be administered at the same time until PT-INR increases into therapeutic range to avoid acute recurrent stroke. However when we start with dabigatran which has rapid action, heparin is usually not required.
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Masahiro Yasaka (2011) conducted a review in Acute cardioembolic stroke and atrial fibrillation. Thrombolysis (rt-PA) and anticoagulant therapy was evaluated. In the acute phase of cardioembolic stroke, rt-PA thrombolysis is recommended within three hours of onset, while the initiation of immediate anticoagulation requires individual risk-benefit assessment.
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