Antithrombotic Therapy for Stroke Patients with Cardiovascular Disease

Aaron M. Gusdon; Salia Farrokh; James C. Grotta

doi:10.1055/s-0041-1726331

Seminars in Neurology, Table of Contents

Semin Neurol 2021; 41(04): 365-387
DOI: 10.1055/s-0041-1726331

Review Article

Antithrombotic Therapy for Stroke Patients with Cardiovascular Disease

Aaron M. Gusdon

¹Department of Neurosurgery, UTHealth Neurosciences, McGovern School of Medicine, University of Texas Health Science Center, Houston, Texas

,

Salia Farrokh

²Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland

,

James C. Grotta

³Mobile Stroke Unit, Memorial Hermann Hospital, Texas Medical Center, Houston

› Author Affiliations

Abstract

Prevention of ischemic stroke relies on the use of antithrombotic medications comprising antiplatelet agents and anticoagulation. Stroke risk is particularly high in patients with cardiovascular disease. This review will focus on the role of antithrombotic therapies in the context of different types of cardiovascular disease. We will discuss oral antiplatelet medications and both IV and parental anticoagulants. Different kinds of cardiovascular disease contribute to stroke via distinct pathophysiological mechanisms, and the optimal treatment for each varies accordingly. We will explore the mechanism of stroke and evidence for antithrombotic therapy in the following conditions: atrial fibrillation, prosthetic heart values (mechanical and bioprosthetic), aortic arch atherosclerosis, congestive heart failure (CHF), endocarditis (infective and nonbacterial thrombotic endocarditis), patent foramen ovale (PFO), left ventricular assist devices (LVAD), and extracorporeal membrane oxygenation (ECMO). While robust data exist for antithrombotic use in conditions such as atrial fibrillation, optimal treatment in many situations remains under active investigation.

Keywords

antithrombotics - antiplatelets - anticoagulation - cardiovascular disease - stroke

Full Text

References

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