Siepen, Bernhard M.; Seiffge, David Julian; Fischer, Urs (2022). Anticoagulation after stroke: persistent uncertainties. Current opinion in neurology, 35(1), pp. 55-61. Wolters Kluwer Health 10.1097/WCO.0000000000001009
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Siepen__2021__Anticoagulation_after_stroke.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (1MB) |
PURPOSE OF REVIEW
Direct oral anticoagulants (DOAC) are the mainstay of anticoagulant therapy for stroke prevention in patients with nonvalvular atrial fibrillation. Persistent uncertainties remain in different areas, and this review discusses current dilemmas based on selected studies.
RECENT FINDINGS
Optimal timing of DOAC initiation after a recent ischaemic stroke in patients with atrial fibrillation is currently unknown and subject of ongoing randomized controlled trials. Ischaemic stroke despite anticoagulant therapy in patients with atrial fibrillation is frequent, constitutes heterogeneous causes (competing stroke cause, medication error and cardioembolism despite anticoagulation) and optimal treatment is currently unknown. Thorough etiological work-up is justified. Recent randomized controlled trials found no beneficial effect of DOAC therapy in unselected patients with embolic stroke of undetermined source (ESUS). Currently ongoing trials targeting subgroup of ESUS patients with additional atrial cardiopathy will provide novel data. Cerebral mircobleeds combined in a novel risk score (MICON score) provide good predictive value to stratify the risk of intracranial haemorrhage in patients taking anticoagulants. Use of DOAC after intracerebral haemorrhage in patients with atrial fibrillation is subject of ongoing trials.
SUMMARY
There are still significant uncertainties in anticoagulant management in patients with stroke. Ongoing trials will soon provide novel data to improve management of these patients.
Item Type: |
Journal Article (Review Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology |
Graduate School: |
Graduate School for Health Sciences (GHS) |
UniBE Contributor: |
Siepen, Bernhard Matthias, Seiffge, David Julian, Fischer, Urs Martin |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1473-6551 |
Publisher: |
Wolters Kluwer Health |
Language: |
English |
Submitter: |
Chantal Kottler |
Date Deposited: |
17 Dec 2021 15:30 |
Last Modified: |
02 Mar 2023 23:35 |
Publisher DOI: |
10.1097/WCO.0000000000001009 |
PubMed ID: |
34812748 |
BORIS DOI: |
10.48350/162038 |
URI: |
https://boris.unibe.ch/id/eprint/162038 |
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