Newer Anticoagulants Should Not Be Used for Off-Label Indications
We are presented here with a sketchy story of a presumed recent stroke onset that is embolic-looking while taking aspirin and clopidogrel for a coronary stent that had been inserted some 6 months earlier. Presumably, imaging consisting of computed tomography or magnetic resonance had shown large artery infarcts in differing arterial territories and of varying ages. Whether earlier infarcts had occurred before the introduction of antiplatelet agents is unknown. Also unknown is the duration of telemetry, which was reported as normal. In this context, should we prescribe a new oral anticoagulant (NOAC)? I will say no, but let’s go back to the beginning.
My first reaction is that I need more information. I might be old-fashioned, but a thorough history and examination would be a good start. Were there any previous stroke symptoms? What were the clinical details of the decision to insert the coronary stent? Are there any potential contraindications to anticoagulant therapy such as peptic ulcer or poorly controlled hypertension? I would like to review the films to confirm the presence …