Stroke and anti-coagulants

[Nik]

I was wondering if anybody on the forum could help with a query I have. I've been reading some guidelines on management of patients who have suffered stroke (ischaemic) and in one set of guidelines (RCP) anti-cogaulation therapy shouldn't be started until 14 days after disabling ischaemic stroke. Can anyone shed any light on why this timeframe is recommended ?. Recent guidelines by the Royal College of Physicians references the NICE guidelines on stroke, but after going through those I'm none the wiser. Any help would be greatly appreciated.

[johnep]

If caused by a clot, then anticoags, if caused by a bleed then anticoags contraindicated. Guess time span to give chance to find out which type.
johnep

[Nik]

Thanks John - I understand the contraindications re haemorrhagic stroke + anticoags but where I mentioned the 14 day wait for giving anticoags it was in reference to after being diagnosed with ischaemic stroke.

[Nik]

Looks like I'll have to dig further then.

[Shwampa]

I hope dear friend you understand the difference between thrombolytics and anticoagulants, while the former should be used early on for better outcomes the latter could lead to serious intracranial bleeding.

http://circ.ahajournals.org/cgi/reprint/115/20/e478.pdf

Extract

1. Urgent anticoagulation with the goal of preventing
early recurrent stroke, halting neurological worsening,
or improving outcomes after acute ischemic stroke is
not recommended for treatment of patients with acute
ischemic stroke (Class III, Level of Evidence A)This
recommendation may change if additional data demon-
strate the usefulness of very early intravenous admin-
istration of anticoagulants for treatment of patients
with infarctions secondary to large-artery thrombosis
or cardioembolism. Urgent anticoagulation should not
be used in lieu of intravenous thrombolysis for treat-
ment of otherwise eligible patients (Class III, Level of
Evidence A)
2. Urgent anticoagulation is not recommended for pa-
tients with moderate to severe strokes because of an
increased risk of serious intracranial hemorrhagic com-
plications (Class III, Level of Evidence A)
3. Initiation of anticoagulant therapy within 24 hours of
treatment with intravenously administered rtPA is not
recommended (Class III, Level of Evidence B)

[Chirpy]

As above - I seem to remember that after an ischaemic stroke giving aspirin too early could increase the risk of 'converting' it further to haemorrhagic stroke. I always used to think of it as being already damaged so likely to worsen if you weren't careful- but this may have been me oversimplifying!!

[Nik]

I hope dear friend you understand the difference between thrombolytics and anticoagulants, while the former should be used early on for better outcomes the latter could lead to serious intracranial bleeding.

Yes i fully understand i went through NICE guidance and RCP guidance but i specifically wanted to know why two weeks. Thanks for the response, you've definately shed some light on it but the exam (the reason i asked initially) was a couple of weeks ago .