Among the different subtypes of
ischaemic strokes, almost 20 % are of cardiac origin. Different are the causes of
cardioembolic stroke, but the most common is the
atrial fibrillation, a supraventricular
arrhythmia. Appropriate use of
antiplatelet drugs and
anticoagulants after transient ischaemic attack (TIA) or
ischaemic stroke depends on whether the underlying cause is cardioembolic or of presumed arterial origin. Adequate antiplatelet
therapy is recommended for
secondary prevention after cerebral ischaemia of presumed arterial origin, whether for patients with TIA and
ischaemic stroke of cardiac origin, mainly due to
atrial fibrillation.
Vitamin K antagonists (VKAs) are highly effective in preventing recurrent
ischaemic stroke but have important limitations and are thus underused. Current guidelines still regard
Vitamin K Antagonists at INR 2·0-3·0 to be the standard treatment after cerebral ischaemia of cardiac origin for patients who can tolerate them. In this setting antiplatelet
therapy provides an alternative when oral anticoagulation is contraindicated or when patient choice or compliance limits choice of
therapy, but is much less effective than VKAs. Recent trial data performed with new anticogulants such as the
factor Xa and
thrombin inhibitors will need to be taken into account, in order to prevent several of the clinical problems actually related to VKAs use.