Anticoagulation: is there still a role in atherothrombotic stroke?

The title suggests that anticoagulation may no longer have a role in the treatment of atherothrombotic cerebrovascular disease. While evidence from recent studies has not shown a distinct benefit of anticoagulation following acute stroke, the designs of these studies may not have distinguished important differences in stroke types adequately. Before judging anticoagulation, we will review the pathogenesis of atherothrombotic stroke and consider the historical role of anticoagulation in its treatment by analyzing early and recent treatment trials. Although questions remain about timing and duration of treatment, the effectiveness of anticoagulation in preventing recurrent cardiac source cerebral embolism has generally been accepted and therefore will not be discussed.