Prevention of Cardioembolic Stroke

William David Freeman, Maria I. Aguilar

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Cardiac causes of ischemic stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic stroke. The most common cause of cardioembolic stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of cardioembolic stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without stroke (up to 20% of the population), and it is a controversial source of cryptogenic stroke. The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.

Original languageEnglish (US)
Pages (from-to)488-502
Number of pages15
JournalNeurotherapeutics
Volume8
Issue number3
DOIs
StatePublished - Jul 2011

Fingerprint

Stroke
Atrial Fibrillation
Antithrombins
Warfarin
Hemorrhage
Patent Foramen Ovale
Endocarditis
Embolism
Drug Interactions
Echocardiography
Thrombosis
Therapeutics
Blood Platelets
Arteries
Myocardial Infarction
Magnetic Resonance Imaging
Technology
Incidence
Population

Keywords

  • Anti-coagulation
  • Atrial fibrillation
  • Cardiac
  • Cardioembolic stroke
  • Myocardial infarction
  • Stroke

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Clinical Neurology
  • Pharmacology

Cite this

Prevention of Cardioembolic Stroke. / Freeman, William David; Aguilar, Maria I.

In: Neurotherapeutics, Vol. 8, No. 3, 07.2011, p. 488-502.

Research output: Contribution to journalArticle

Freeman, WD & Aguilar, MI 2011, 'Prevention of Cardioembolic Stroke', Neurotherapeutics, vol. 8, no. 3, pp. 488-502. https://doi.org/10.1007/s13311-011-0048-y
Freeman, William David ; Aguilar, Maria I. / Prevention of Cardioembolic Stroke. In: Neurotherapeutics. 2011 ; Vol. 8, No. 3. pp. 488-502.
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