[2008] 1.4.18 For people with prosthetic valves who have disabling cerebral infarction and who are at significant risk of haemorrhagic transformation, stop anticoagulation treatment for 1 week and substitute aspirin 300 mg. 1.4.19 Ensure that people with ischaemic stroke and symptomatic proximal deep vein thrombosis or pulmonary embolism receive anticoagulation treatment in preference to treatment with aspirin unless there are other contraindications to anticoagulation. [2008] 1.4.20 Treat people who have haemorrhagic stroke and symptomatic deep vein thrombosis or pulmonary embolism to prevent the development of 2022 further pulmonary emboli using either anticoagulation or a caval filter. Statin treatment 1.4.21 Immediate initiation of statin treatment is not recommended in people with acute stroke (see additional information). [2008] 1.4.22 Continue statin treatment in people with acute stroke who are already receiving statins. [2008] 1.5 Maintenance or restoration of homeostasis Supplemental oxygen therapy 1.5.1 Give supplemental oxygen to people who have had a stroke only if their oxygen saturation drops below 95%. The routine use of supplemental oxygen is not recommended in people with acute stroke who are not Be aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes. Blood sugar control 1.5.2 Maintain a blood glucose concentration between 4 and 11 mmol/litre in people with acute stroke. [2008] 1.5.3 Provide optimal insulin therapy, which can be achieved by the use of intravenous insulin and glucose, to all adults with type 1 diabetes with threatened or actual stroke. Critical care and emergency departments should have a protocol for such management. 