Early recurrence of ischaemic stroke of cardioembolic cause and delayed anticoagulation: a case report

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Abstract

Introduction: Anticoagulation therapy is used for the management of atrial fibrillation to prevent new clots from developing. However, neurologists face the challenge of when to initiate/reintroduce treatment after a recent episode of stroke without increasing haemorrhagic risk, especially if the stroke is large and/or complicated with haemorrhagic transformation.

Case presentation: This report describes the case of a 72-yearold man who had an ischaemic stroke of the right posterior cerebral artery. The patient had permanent atrial fibrillation, discovered in hospital. He was not on chronic anticoagulation therapy before stroke. His anticoagulation therapy was postponed due to a haemorrhagic lesion, leading to new ischaemic stroke. The patient suddenly had right hemiplegia with aphasia for which a mechanical thrombectomy was performed but complicated by embolization into the left posterior cerebral artery with failure of thromboaspiration of this clot. Finally, the patient presented with intracranial hypertension due to ischaemic lesions and died 3 days after his readmission.

Conclusion: When to start anticoagulation therapy after ischaemic stroke is an unresolved question but should be discussed at least twice weekly in a stroke unit based on the clinical evolution of the patient.

Keywords: anticoagulation, atrial fibrillation, cardioembolic, haemorrhagic transformation, ischaemic stroke.

Citation: Aghetti A, Reiner P. Early recurrence of ischaemic stroke of cardioembolic cause and delayed anticoagulation: a case report. Drugs Context. 2022;11:2021-10-5. https://doi.org/10.7573/dic.2021-10-5

Contributions: All authors contributed equally to the preparation of this manuscript. They also contributed to patient care. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: AA has received personal fees and non-financial support from Bayer. PR has received personal fees and non-financial support from Bayer, BMS, AstraZeneca and Pfizer. She also received non-financial support from Boehringer Ingelheim. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2022/03/dic.2021-10-5-COI.pdf

Acknowledgements: The authors are thankful to the family of the patient. Content Ed Net PSI SAS (France) provided editorial and medical writing assistance for the preparation of this manuscript.

Funding declaration: The authors retained the editorial process (including the discussion at all times) and the views and opinions expressed are those of the authors. There was no financial reward for authors associated with preparing the manuscript. Content Ed Net PSI SAS (France) provided editorial and medical writing assistance for the preparation of this manuscript; this assistance was funded by Bayer Healthcare SAS within the scope of an unrestricted medical educational grant.

Copyright: Copyright © 2022 Aghetti A, Reiner P. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0, which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2022 Aghetti A, Reiner P. https://doi.org/10.7573/dic.2021-10-5. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/early-recurrence-of-ischaemic-stroke-of-cardioembolic-cause-and-delayed-anticoagulation-a-case-report

Correspondence: Peggy Reiner, Department of Neurology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France. Email: peggy.reiner@aphp.fr

Provenance: Submitted; externally peer reviewed.

Submitted: 12 October 2021; Accepted: 28 February 2022; Publication date: 7 April 2022.

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