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