Antiplatelets and anticoagulation in stroke – Quick reference guide Clinical Guideline

This guidance is adapted from NICE TA210-Clopidogrel and modified release dipyridamole for the prevention of occlusive vascular events.

Ischaemic Ischaemic Stroke Definite TIA + AF stroke/ TIA + AF (no acute changes on CT and no Haemorrhagic residual neurological deficit) stroke on CT

Stat Aspirin STOP WARFARIN, DABIGATRAN, APIXABAN, 300mg PO/PR EDOXABAN or RIVAROXABAN (NOACs) if unable if already taking for AF Initiate warfarin if no contra-indications: If on warfarin: to swallow If for any other indication discuss with Stroke Start with 2mg daily for one week STOP Consultant before stopping. Aim for INR 2-3. Continue aspirin until Consider Give: reversal Clopidogrel INR >2 Aspirin 300mg daily for 2 weeks (see formulary) 75mg daily* OR If on NOAC: Long term for Initiate DABIGATRAN OR EDOXABAN STOP secondary OR APIXABAN OR RIVAROXABAN

prevention For further information on NOAC dosing, (*unlicensed for contraindications, monitoring and drug Initiate warfarin if no contra-indications: TIA) interactions refer to anticoagulation Start with 2mg daily for one week guideline. Avoid antiplatelets Aim for INR 2-3. Continue aspirin until INR >2 OR anticoagulants, If Clopidogrel Initiate DABIGATRAN OR APIXABAN OR low molecular contra-indicated EDOXABAN OR RIVAROXABAN weight heparin or not tolerated: For further information on NOAC dosing, and NSAIDs Aspirin 75mg contraindications, monitoring and drug daily with interactions refer to anticoagulation guideline If warfarin or NOAC contra-indicated: Dipyridamole Continue aspirin 300mg daily M/R 200mg BD long term for secondary long term prevention Antiplatelets and anticoagulation in stroke-Quick reference guide-clinical guideline, v3 Principal author: Geraldine McKerrell Approved by WDTP Jan 2016 Review by: April 2018 Updated: Heather Bury & Dr R Davies