Prophylactic anticoagulants in managing embolic stroke.
The primary risk of anticoagulant therapy in cardiac embolic stroke is hemorrhage--particularly cerebral hemorrhage in the elderly. Improving the benefit/risk ratio for indicated anticoagulation involves consideration of the following: hemostatic competence, blood pressure, drug interactions, falls, interval surgery, diet, aspirin and last but not least, the intensity of anticoagulant prophylaxis. For the present it would be prudent to limit heparin administration to a low-dose regimen not exceeding 20,000 units/24 hours and warfarin maintenance to a low-dose prothrombin time ratio of 1.5.