In pulmonary embolism, we institute anticoagulation immediately following the alteplase infusion.

In Ischaemic stroke and atrial Fibrillation,  we anticoagulant in two weeks. There is a recent paper explaining safety of anticoagulation within 7 days of onset of  lacunar strokes.

In myocardial infarction, you start heparin immediately in addition to dual antiplatelet then stop heparin  in 3-5 days. Antiplatelet treatment  should continue

Oral anticoagulation immediately after pumonary embolism,

OAT or NOAC 2 weeks after stroke

iv heparin plus double oral antiplatelets immediately after AMI

Oral ac sudden, Or low molecullar heparine medicaments...

If you decide to use warfarin for oral anticoagulation in In pulmonary embolism you must start heparin immediately while you also start warfarin. Reason is warfarin binds reversibly to protein C, and protein S; both are natural anticoagulants; this creates a pro - thrombotic state for 3-5 days when you must cover with heparin. Then this binding breaks down and you continue on warfarin only afterwards. Also warfarin will need time to exhaust liver storage of vitamin K.

If you decide on NOAC, you can go for them with no heparin cover.

Thanks

Hi.. Juan very important questions.. After pulmonary embolism you start iv heparin immediately. Warferin should be overlapped with iv heparin for 3days.Newer anticoagulent you can start any time.. After MI you use dual antiplatelets and heparin immediately. If you use streptokinase as thrombolytic agent then heparin should be started six hour latter to avoid bleeding complication.. After stroke if there is large infarction then anticoagulent to be started after two weeks or more to avoid haemorraghic conversion.. In small infarction you can start anticoagulation earlier.. Thanks