Would you consider anticoagulation for a young patient with a recent embolic stroke and newly diagnosed global cardiac hypokinesis with ejection fraction of less than 25%?

Yes, I would consider anticoagulation but the evidence is indirect.

There is reasonable data in persons with heart failure with reduced ejection fraction that ischemic stroke is reduced with anticoagulation compared to antiplatelet therapy alone. But essentially all large RCTs are limited in that the primary outcomes of the trials were mostly primary stroke prevention and the endpoint was composite outcomes that included mortality as well as stroke. We do not have good answers for persons with prior ischemic stroke focusing on recurrent ischemic stroke the main question.

WATCH and WARCEF trials were RCTs for patients with low that compared warfarin versus antiplatelet and <15% had prior ischemic stroke at enrollment. Both showed a significan...