What are the AHA/ASA guidelines for antithrombotic therapy in cardioembolic transient ischemic attack (TIA)?

Updated: Dec 03, 2018
  • Author: Ashish Nanda, MD; Chief Editor: Andrew K Chang, MD, MS  more...
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Answer

In patients who have atrial fibrillation in association with a TIA, long-term anticoagulation with warfarin to a target international normalized ratio (INR) of 2-3 is typically recommended. Aspirin 325 mg/day is recommended for patients unable to take oral anticoagulants. However, the addition of clopidogrel to aspirin therapy, compared with aspirin therapy alone, might be reasonable. For most patients with a stroke or TIA in the setting of AF, it is reasonable to initiate oral anticoagulation within 14 days after the onset of neurological symptoms. Anticoagulation can be delayed beyond 14 days in the presence of high risk for hemorrhagic conversion. [46]

The 2014 AHA/ASA guidelines also state that bridging therapy with subcutaneous low-molecular-weight heparin (LMWH) is reasonable for patients with atrial fibrillation who require temporary interruption of oral anticoagulation but are at high risk for stroke. [46]

In acute myocardial infarction (MI) with left ventricular thrombus, oral anticoagulation with warfarin (target INR, 2-3) is reasonable. [46]


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