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Chapter 18 - Drugs, Devices, and Procedural Therapies to Prevent Recurrent Cardiogenic Embolic Stroke

from Part V - Prevention

Published online by Cambridge University Press:  15 December 2020

Jeffrey L. Saver
Affiliation:
David Geffen School of Medicine, University of Ca
Graeme J. Hankey
Affiliation:
University of Western Australia, Perth
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Summary

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.

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Information
Stroke Prevention and Treatment
An Evidence-based Approach
, pp. 337 - 383
Publisher: Cambridge University Press
Print publication year: 2020

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