What are the benefits and risks of early anticoagulation for disabling stroke?
Early anticoagulation with Vitamin K antagonists (VKAs) may lead to fewer ischemic strokes without an increase in intracranial bleeding, as well as reduced mortality and disability. Conversely, a systematic review and meta-analysis of 7 randomized trials of unfractionated heparin (UFH), low molecular weight heparin (LMWH), or heparinoids found that early anticoagulation was associated with nonsignificantly reduced recurrent ischemic stroke but with increased intracranial bleeding, and no reduction in death or disability. Observational studies suggest that the use of LMWH (as a bridging strategy) together with oral anticoagulation is associated with a higher risk of symptomatic hemorrhage. Observational studies also suggest that early (< 14 days) anticoagulation with non-vitamin K antagonist oral anticoagulants (NOACs) might be safe. However, further research is needed to determine the benefits and risks of early anticoagulation for disabling stroke.