title: Anticoagulation in acute ischemic stroke: A systematic search.
abstract: BACKGROUND
  Stroke is one of the most important diseases worldwide. Several clinical scenarios demand full dose of anticoagulants primary to stroke etiology or to the treatment of comorbidity. However, controversy exists over many issues regarding anticoagulation treatment in stroke such as time for initiation, efficacy according to stroke etiology, the ideal dose of anticoagulants, and whether novel anticoagulants should be used.
  
  
  METHODS
  Computerized search for clinical trials and randomized controlled clinical trials was done to the present date at Medline, Scielo, Embase, PsychInfo, and Cochrane Library using MeSH terms and the keywords stroke, ischemic stroke, anticoagulation, anticoagulants, heparin, low-molecular-weight heparin, warfarin, dabigatran, rivaroxaban, apixaban. The PRISMA statement was used to evaluate clinical trials.
  
  
  RESULTS
  Fourteen clinical trials were selected based on inclusion criteria. No evidence was found supporting the early use of heparin, heparinoids or low-molecular-weight heparin (LMWH) early after stroke. No consistent evidence for the use of warfarin and the newer oral anticoagulants were found. Argatroban was the only anticoagulant with significant positive results early after large-artery ischemic stroke.
  
  
  CONCLUSIONS
  The ideal time for initiating anticoagulation remains undefined, requiring further investigation. Early anticoagulation for ischemic stroke is not recommended, with few exceptions, such as that of argatroban.
authors.affiliation: Department of Internal Medicine, Faculdade de Medicina de Jundiaí, Jundiaí, SP, Brazil.
authors.forename: Nayara L
authors.initials: NL
authors.lastname: Froio
authors.affiliation: Department of Internal Medicine, Faculdade de Medicina de Jundiaí, Jundiaí, SP, Brazil.
authors.forename: Richard Murdoch
authors.initials: RM
authors.lastname: Montgomery
authors.affiliation: Department of Internal Medicine, Faculdade de Medicina de Jundiaí, Jundiaí, SP, Brazil.
authors.forename: Elias
authors.initials: E
authors.lastname: David-Neto
authors.affiliation: Department of Internal Medicine, Faculdade de Medicina de Jundiaí, Jundiaí, SP, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Aprahamian
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants