Common indications for anticoagulation to prevent stroke may include:

• Cardiac sources of emboli such as atrial fibrillation, valvular disease, myocardial wall motion abnormalities, prosthetic materials, or paradoxical emboli
• Hypercoagulable states such as anticardiolipin antibodies or inherited conditions
• Arterial dissection
• Intracranial sinus thrombosis

These indications are in flux. For example, the evidence that anticoagulation is better than antiplatelet agents for dissection is not at all strong. A recent meta-analysis suggested that, in the setting of acute cardioembolic stroke, immediate heparinization increased the incidence of hemorrhage without reducing that of recurrent stroke in the short term. This has led many experts to recommend the more gradual process of warfarinization in that setting.

How long to continue anticoagulation depends on the reason for starting it in the first place. For example, a patient with arterial dissection is usually anticoagulated for 3-6 months while a patient with continuing atrial fibrillation may require lifelong treatment.

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