OACs after stroke

Dr. Katie Lin, the latest guidance with regards to initiation of oral anticoagulants in stroke patients follows the AHA/Canadian Stroke Best Practice Guidelines is the “1-3-6-12 rule”, which states that OAC may be initiated based on size of infarct as follows:

TIA with no visible infarct on imaging – 24hrs post event
Minor stroke (NIHSS<8) with small visible infarct – 3 days
Moderate stroke (NIHSS 8-15) with moderate size infarct – 6 days
Large stroke (NIHSS>15) with large infarct – 12 days

Additionally, any patient with a visible stroke on imaging should likely have repeat imaging prior to initiation of OAC to rule out hemorrhagic transformation.