Today we talked about a case of a patient with a presumed cardioembolic (atrial fibrillation mediated) TIA and evidence of old parieto-occipital stroke.
We discussed the use of anticoagulants such as warfarin in atrial fibrillation and the CHADS2 score. This patient was "warfarin allergic". Often this is an allergy to the dye in the tablets, and one can use dye free tablets.
In these patients you can also consider nicoumalone (Sintrom) which is another oral vitamin K antagonist that is structurally different (and twice as potent). An alternative (though I am unsure of its availability in Canada) is Anisindione.
This is a great review article on the use of oral vitamin K antagonists.
In acute stroke bridging with LMWH or UFH while waiting for a therapeutic INR is usually not indicated
Note that it probably would be indicated in patients with prosthetic valves who have had embolic strokes.
We also discussed TIAs and the ABCD2 score for prognosticating the risk of stroke in TIA.
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