[CK] Acute infarct or TIA without evidence of mechanical or existing thrombus = NO AC. ONLY ASA for now!!! TIA WITHOUT AC! (1week)

https://www.uptodate.com/contents/antithrombotic-treatment-of-acute-ischemic-stroke-and-transient-ischemic-attack?search=tia&sectionRank=3&usage_type=default&anchor=H346089098&source=machineLearning&selectedTitle=5~150&display_rank=5#H1180709

ACUTE ANTITHROMBOTIC THERAPY: 1-2weeks to resume. If it's pretty small/TIA, then oral AC could be earlier after 24hours. Small: 1 week without IV. With PO(as early as after 24hours in cardioembolic with Coumadin! for the small but high risk of recur)Large: 2 weeks===> BiG  no!! ask neuro. mostly 2weeks.====> Small. Can be initiated in 1 week. but Early coumadin is still safe.. TIA.In patients with atrial fibrillation who suffer an ischemic stroke, acute antithrombotic therapy (algorithm 1 and algorithm 2) may be warranted both to reduce disability and the risk of early recurrent stroke, which is 3 to 5 percent in the first two weeks [11,12]. These benefits must be balanced against the risk of intracranial bleeding with antithrombotic therapy. The management of acute antithrombotic therapy in patients with stroke is discussed in detail elsewhere. (See "Antithrombotic treatment of acute ischemic stroke and transient ischemic attack".)

Anticoagulants were associated with a nonsignificant reduction in recurrent ischemic stroke within 7 to 14 days (3.0 versus 4.9 percent, odds ratio [OR] 0.68, 95% CI 0.44-1.06)

●Anticoagulants were associated with a statistically significant increase in symptomatic intracranial hemorrhage (2.5 versus 0.7 percent, OR 2.89, 95% CI 1.19-7.01)

●Anticoagulants and other treatments had a similar rate of death or disability at final follow-up (approximately 74 percent)

Thus, the results do not support early anticoagulant treatment of acute cardioembolic stroke [28].

While parenteral anticoagulation is not recommended during the first 48 hours after acute ischemic stroke, oral anticoagulation is recommended for secondary stroke prevention in patients with atrial fibrillation and other high-risk sources of cardiogenic embolism. The timing of its initiation for such patients is mainly dependent on the size of the infarct, which is presumed to correlate with the risk of hemorrhagic transformation. Thus, for medically stable patients with a small or moderate-sized infarct, warfarin can be initiated soon (after 24 hours) after admission with minimal risk of transformation to hemorrhagic stroke, while withholding anticoagulation for two weeks is generally recommended for those with large infarctions, symptomatic hemorrhagic transformation, or poorly controlled hypertension. (See "Stroke in patients with atrial fibrillation", section on 'Timing after acute ischemic stroke'.)