When should warfarin be considered for stroke patients?
Warfarin is not recommended as an alternative to aspirin for prevention of thrombotic strokes that are not caused by cardioembolism. In two trials comparing warfarin to aspirin for secondary stroke prevention in noncardioembolic stroke, warfarin was found to be too dangerous when the patient’s international normalization ratio (INR) was 3.0 to 4.5 and of no benefit when the INR was 1.4 to 2.8. Warfarin should be reserved for patients with cardioembolic stroke or atrial fibrillation. It may be considered to prevent stroke recurrence in the clinical situations of cervical carotid and vertebral artery dissections, cerebral venous thrombosis, and known hypercoagulable states. • In patients with atrial fibrillation (AF), what is the recommended treatment to prevent stroke? Multiple randomized controlled trials have demonstrated that the use of long-term antithrombotic therapy with warfarin or aspirin reduces the relative risk of stroke caused by AF by approximately 65 percent and 20 percent
