The optimal treatment of acute cardioembolic stroke represents a balance between reducing early recurrence of embolism and of precipitating secondary brain haemorrhage. About 12% of patients with an acute cardioembolic stroke have a recurrence within 2 weeks; the figure rises to about 20% if there is an associated atrial fibrillation.
Intravenous heparin should be given 48 hours after the event. The delay is advised because of the propensity of cardioembolic strokes to undergo secondary haemorrhagic transformation. Anticoagulation should be delayed until 7-10 days following the event if there are severe neurological deficits.
Antibiotics per se, are associated with reduced recurrence when the suspicion is infective endocarditis.
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