Ischaemic stroke in anticoagulated patients with atrial fibrillation.

Stretz, Christoph; Wu, Teddy Y; Wilson, Duncan; Seiffge, David J.; Smith, Eric E; Gurol, M Edip; Yaghi, Shadi (2021). Ischaemic stroke in anticoagulated patients with atrial fibrillation. Journal of neurology, neurosurgery, and psychiatry, 92(11), pp. 1164-1172. BMJ Publishing Group 10.1136/jnnp-2020-323963

Text Stretz__2021__Ischaemic_stroke_in_anticoagulated_patients.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (467kB)

Anticoagulation substantially reduces the risk of stroke in patients with atrial fibrillation (AF). However, recent studies have shown that up to 22%-36% of patients on anticoagulation will suffer an ischaemic stroke (IS). In this narrative review, we provide an overview of risk factors, mechanisms, management of acute IS and strategies for secondary prevention for patients with AF with stroke despite oral anticoagulation. For this paper, we reviewed available literature from important studies (randomised clinical trials, meta-analyses, reviews and case series) on patients with IS despite anticoagulation. We focused on recent studies that examined safety and efficacy of acute stroke treatments and evaluation and management strategies for secondary prevention. The literature review suggests that patients with AF with IS despite anticoagulation are a heterogeneous group with several possible mechanisms, which may include reduced or non-adherence to anticoagulation, competing non-cardioembolic stroke aetiologies or cardioembolic mechanisms separate from AF. The identification of one or more possible mechanisms of stroke despite anticoagulation may allow for a more targeted and individualised approach for secondary prevention. There are limited data to guide management in such patients, and strategies to prevent recurrent strokes include strict risk factor control and therapies targeting the most likely stroke mechanism. In cases where AF is suspected to be the culprit, clinical trials are needed to test the safety and efficacy of left atrial appendage occlusion plus anticoagulation versus continued anticoagulation alone.

Interest & Impact

Downloads

1 since deposited on 22 Nov 2021
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item