[2008] 1.4.12 Do not use anticoagulation treatment routinely for the treatment of acute stroke (see additional information). [2008] People with acute venous stroke 1.4.13 Offer people diagnosed with cerebral venous sinus thrombosis (including those with secondary cerebral haemorrhage) full-dose anticoagulation treatment (initially full-dose heparin and then warfarin [international normalised ratio 2 to 3]) unless there are comorbidities that preclude its 2022 People with stroke associated with arterial dissection 1.4.14 Offer either anticoagulants or antiplatelet agents to people who have stroke secondary to acute arterial dissection. [2008, amended 2019] People with acute ischaemic stroke associated with antiphospholipid syndrome 1.4.15 Manage acute ischaemic stroke associated with antiphospholipid syndrome in the same way as acute ischaemic stroke without antiphospholipid syndrome (see additional information). [2008] Reversal of anticoagulation treatment in people with haemorrhagic stroke 1.4.16 Return clotting levels to normal as soon as possible in people with a primary intracerebral haemorrhage who were receiving warfarin before their stroke (and have elevated international normalised ratio). Do this by reversing the effects of the warfarin using a combination of prothrombin complex concentrate and intravenous vitamin K. [2008, amended 2019] Anticoagulation treatment for other comorbidities 1.4.17 Ensure that people with disabling ischaemic stroke who are in atrial fibrillation are treated with aspirin 300 mg for the first 2 weeks before anticoagulation treatment is considered. [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. 