Timing of anticoagulation therapy in patients with acute ischaemic stroke and atrial fibrillation

Maurizio Paciaroni; Giancarlo Agnelli; Walter Ageno; Valeria Caso

doi:10.1160/TH16-03-0217

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 116(03): 410-416
DOI: 10.1160/TH16-03-0217

Review Article

Schattauer GmbH

Timing of anticoagulation therapy in patients with acute ischaemic stroke and atrial fibrillation

Maurizio Paciaroni

¹Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy

,

Giancarlo Agnelli

¹Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy

,

Walter Ageno

²Department of Internal Medicine, Insubria University, Varese, Italy

,

Valeria Caso

¹Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy

› Author Affiliations

Abstract

Summary

In patients with acute stroke and atrial fibrillation (AF), the risk of early recurrence has been reported to range between 0.1% and 1.3% per day. Anticoagulants are the most effective therapy for the prevention of recurrent ischaemic stroke in these patients, but randomised clinical trials have failed to produce any evidence supporting the administration of heparin within 48 hours from stroke onset as it has been associated with a non-significant reduction in the recurrence of ischaemic stroke, no substantial reduction in death and disability, and an increase in intracranial bleeding. As early haemorrhagic transformation is a major concern in the acute phase of stroke patients with AF, determining the optimal time to start anticoagulant therapy is essential. This review which focuses on the epidemiology of recurrent ischaemic stroke and haemorrhagic transformation in patients with acute ischaemic stroke and AF, proposes a model for decision making on optimal timing for initiating anticoagulation, based on currently available evidence.

Keywords

Atrial fibrillation - ischaemic stroke - secondary prevention - acute therapy

Full Text

References

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