Re: Anticoagulation in acute stroke patients with AF and prosthetic valves.

• The group of patients where this issue is of prime importance is when considering those groups of patients with underlying Atrial Fibrillation (AF) and prosthetic heart valves. The risk of embolisation is increased with mitral valve prostheses, caged ball devices and multiple prosthetic valves. • It is equally of paramount importance to calculate the thromboembolic risk by applying the CHADS2 score. If the score is 2 or above, we should consider bridging anticoagulation with unfractionated heparin or low molecular weight heparin [2]. Heparin has the advantages where regular monitoring is required and can be reversed rapidly in the event of intracranial bleeding. We recommend a multidisciplinary approach including cardiology colleagues when determining the best form of anticoagulation in such cases.