Anticoagulation after ischemic stroke in patients with atrial fibrillation

Abstract

Atrial fibrillation is a cardiac arrhythmia characterized by the uncoordinated contraction of the atria, significantly increasing the risk of ischemic stroke. Consequently, in order to reduce the risk of bleeding, several clinical trials propose starting anticoagulation after 3, 6, 9, or even 12 days following the ischemic event. However, recent studies indicate that the early initiation of direct oral anticoagulants prevents the recurrence of the ischemic event without increasing the bleeding rate. This literature review aimed to analyze the available scientific evidence on the efficacy, safety, and optimal timing of initiating oral anticoagulation after an ischemic stroke in patients with atrial fibrillation. Information was gathered through meta-search engines Epistemonikos, Tripdatabase, and databases such as Medline, PubMed, Science Direct, Google Scholar, and the Cochrane Library. It was found that, following an ischemic stroke of cardioembolic origin, anticoagulation is the "only" treatment that prevents its recurrence; however, the use of anticoagulant drugs entails a higher risk of bleeding. It was concluded that in patients with ischemic stroke and concomitant atrial fibrillation, the early initiation of anticoagulant treatment with direct oral anticoagulants was non-inferior to delayed reinitiation, being a safe and effective strategy.