Warfarin for prevention of stroke: A practical, clinical review

Robert G. Hart, Robert L. Talbert, Kathie Kadri, Mary Amato

Research output: Contribution to journalReview article

2 Scopus citations

Abstract

BACKGROUND- After two decades of waning enthusiasm for its use, warfarin is increasingly prescribed for the prevention of ischemic stroke. We review the clinical evidence about warfarin for stroke prevention and discuss the practical aspects of its outpatient administration. REVIEW SUMMARY- Anticoagulation is highly efficacious for the primary and secondary prevention of ischemic stroke in patients with nonvalvular atrial fibrillation, the most common cardioembolic source, accounting for nearly 10% of all ischemic strokes. The efficacy and safety of warfarin compared with antiplatelet therapy for patients with primary cerebrovascular diseases are unsettled and are currently being addressed by large clinical trials. Monitoring warfarin therapy with the International Normalized Ratio and using lower intensities of anticoagulation have reduced bleeding complications, a special problem for elderly, stroke-prone patients. Anticoagulation substantially increases the risk of intracranial hemorrhage for many stroke-threatened patients. The risk/benefit equation is complex and must consider the absolute risk reduction in stroke coupled with the bleeding risk in individual patients. CONCLUSION- Neurologists will be increasingly prescribing warfarin for stroke prevention as clinical trials refine knowledge about its benefit and optimal dose/intensity. Warfarin has a relatively narrow therapeutic window; its safe use requires a knowledgeable, committed physician and a patient educated about the basic dos and don'ts of anticoagulation.

Original languageEnglish (US)
Pages (from-to)319-341
Number of pages23
JournalNeurologist
Volume2
Issue number6
StatePublished - Nov 1 1996
Externally publishedYes

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Cerebral embolism
  • Cerebrovascular disease
  • Intracerebral hemorrhage
  • Warfarin

ASJC Scopus subject areas

  • Clinical Neurology

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    Hart, R. G., Talbert, R. L., Kadri, K., & Amato, M. (1996). Warfarin for prevention of stroke: A practical, clinical review. Neurologist, 2(6), 319-341.