Clinical Benefit of Early Anticoagulation in Cardioembolic Stroke

<i>Background:</i> Nonvalvular atrial fibrillation is the most common source of cardiac embolism with a high reported risk of stroke and a high stroke-related mortality. A common clinical dilemma in patients with acute stroke is whether the detection of one of the major cardiac sources of emboli requires an early anticoagulation to reduce early stroke recurrence and mortality. <i>Methods:</i> In this review, we report on the results of clinical trials that have investigated the efficacy of early treatment for acute cardioembolic stroke. <i>Results:</i> Large clinical trials demonstrate that there is no evidence supporting the administration of heparin in patients with acute ischemic stroke within 48 h from stroke onset. <i>Conclusions:</i> The results of recent studies showing an advantage of the very early administration of heparin (<3 h from stroke onset) should encourage clinicians to perform further trials on the efficacy of an early administration of heparin in acute cardioembolic stroke.