Drugs, Devices, and Procedural Therapies to Prevent Recurrent Cardiogenic Embolic Stroke

Research output: Chapter in Book/Conference paperChapterpeer-review

Abstract

Cardiogenic embolism is a common cause of recurrent ischaemic stroke. The cardiac source of embolism is usually the left atrial appendage and atrium due to atrial fibrillation (AF). Other sources include the left ventricle, heart valves and venous system or right atrium, via a patent foramen ovale.The most effective thromboprophylactic is oral anticoagulation, which reduces the risk of recurrent stroke by about two thirds, compared to no anticoagulation. Four target-specific, direct-acting non-vitamin K antagonist oral anticoagulants (NOACs) – the direct thrombin inhibitor dabigatran etexilate, and the factor Xa inhibitors rivaroxaban, apixaban and edoxaban – are at least as efficacious and safe as warfarin, and apixaban is superior to, and as safe as, aspirin, for preventing stroke among patients with AF. Other potential stroke prevention strategies include left atrial appendage occlusion for patients with AF in whom anticoagulation is contraindicated, anticoagulation for left ventricular thrombus and prosthetic heart valves, antibiotics +/– valve surgery for infective endocarditis, and transcatheter device closure of a symptomatic patent foramen ovale.
Original languageEnglish
Title of host publicationStroke Prevention and Treatment
Subtitle of host publicationAn Evidence-based Approach
EditorsJeffrey L. Saver, Graeme J. Hankey
PublisherCambridge University Press
Chapter18
Pages337-383
Number of pages47
Edition2
ISBN (Electronic)9781316286234
ISBN (Print)9781107113145
DOIs
Publication statusPublished - 10 Dec 2020

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