Patients with pulmonary arteriovenous malformation (PAVM) carry an elevated risk of ischaemic stroke. This protocol addresses the specific management question that arises when PAVM is identified in a patient presenting with, or with a history of, ischaemic stroke.
The approach in this setting draws on antiplatelet therapy combined with statins, following standard stroke prevention guidance. Additional considerations apply in certain patient subgroups — the full structured protocol provides the complete decision framework.
DOI: 10.1136/thoraxjnl-2017-211217
PAVM patients are at increased risk of ischaemic stroke and can be managed using antiplatelet agents, but the safety of thrombolysis is not established.
As in the general population, the majority of ischaemic strokes in patients with PAVM are treated with antiplatelet agents, which are generally tolerated well, even when HHT is present.
Statins are also used as per standard stroke prevention guidance.
Anticoagulants are rarely required for prevention of strokes due to PAVMs but may be required if there is concurrent atrial fibrillation or VTE.
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