Stroke - Anticoag

[je355804]

Does anyone know if there is a rule for continuing or stopping anticoagulation in an ischemic stroke patient, in the setting of an individual who requires lifelong anticoagulation?

How about in a patient who has an indication for temporary anticoagulation?

How about in a hemorrhagic stroke? Would you just stop anticoag regardless of their other conditions?

Furthermore, would FFP be appropriate in these patients?

I believe if they've ran their INR up for some reason and then develop a hemorrhagic stroke it would be appropriate (I could be wrong,) however, I'm not sure what to do in the situations above given an appropriate INR for their condition.

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[Jorje286]

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[link2swim06]

Does anyone know if there is a rule for continuing or stopping anticoagulation in an ischemic stroke patient, in the setting of an individual who requires lifelong anticoagulation?

How about in a patient who has an indication for temporary anticoagulation?

How about in a hemorrhagic stroke? Would you just stop anticoag regardless of their other conditions?

Furthermore, would FFP be appropriate in these patients?

I believe if they've ran their INR up for some reason and then develop a hemorrhagic stroke it would be appropriate (I could be wrong,) however, I'm not sure what to do in the situations above given an appropriate INR for their condition.

Do you mean ischemic stroke 2/2 to emboli from a fib?

I am confused what reason you would want to be using an anticoagulant for a stroke.

 

[prometheus09]

Does anyone know if there is a rule for continuing or stopping anticoagulation in an ischemic stroke patient, in the setting of an individual who requires lifelong anticoagulation?

How about in a patient who has an indication for temporary anticoagulation?

How about in a hemorrhagic stroke? Would you just stop anticoag regardless of their other conditions?

Furthermore, would FFP be appropriate in these patients?

I believe if they've ran their INR up for some reason and then develop a hemorrhagic stroke it would be appropriate (I could be wrong,) however, I'm not sure what to do in the situations above given an appropriate INR for their condition.

This is a complicated topic, and you'll get different answers depending on the etiology of the ischemic stroke and depending on other medical conditions. If the patient is at high-risk for developing clots, then I think stopping anticoagulation during an ischemic event would be dangerous and increase risk of further developing clots. I found this link to be useful: http://emedicine.medscape.com/article/1160021-overview

As for hemorrhagic strokes, I would think you would try to reverse any over-anticoagulation (ie: INR too high) with either vit K or FFP. But there is a lot more in play, for example managing increased ICP with mannitol and hyperventilation, controlling risk of seizures, controlling BP without being too aggressive, getting neurosurgery involved in case they need to create burr holes if it's a subdural hemorrhage or more space for the brain to swell if the bleeding is within the brain parenchyma, etc.