What is the clinical evidence from this study?

Study design: Review. Population: Atrial Fibrillation. Intervention: Stroke prevention strategies (DOACs, LAAC, Warfarin).

February 1, 2018Current Neurology and Neuroscience ReportsOpen Access

Atrial Fibrillation for the Neurologist: Preventing both Ischemic and Hemorrhagic Strokes

View Full Paper

Ask AI

Bookmark

Key result

Left atrial appendage closure provides an alternative to life-long anticoagulation for atrial fibrillation patients at high hemorrhagic risk, while direct oral anticoagulants offer a safer alternative to warfarin.

Structured PICO

Population

Patients with atrial fibrillation, particularly those with prior ischemic stroke and/or markers of intracranial hemorrhage (high embolic/hemorrhagic risks)

Intervention

Stroke prevention strategies including direct oral anticoagulants (DOACs) and left atrial appendage closure (LAAC) with the WATCHMAN device, as well as AF detection using implantable loop recorders

Comparator

Warfarin or standard monitoring (as discussed in the context of reviewed trials)

Outcome

Prevention of both ischemic and hemorrhagic strokes

This review highlights the importance of individualized stroke prevention in AF patients by balancing ischemic and hemorrhagic risks through advanced AF detection, DOACs, and left atrial appendage closure.

Implication

May aid anticoagulation decisions in high-bleed-risk AF; leaves open need for head-to-head randomized data.

Abstract

PURPOSE OF REVIEW: This review aims to help neurologists managing atrial fibrillation (AF) patients who had an ischemic stroke and/or with intracranial hemorrhage (ICH) markers, therefore at high embolic/hemorrhagic risks. RECENT FINDINGS: Implantable loop recorders have substantially improved the accuracy of AF detection. Recent research yielded a set of powerful neuroimaging markers that can stratify ICH risk. Direct oral anticoagulants (DOAC) are easier to use with a lower ICH risk than warfarin in a general AF population. Finally, the FDA-approved left atrial appendage closure (LAAC) with the WATCHMAN device provides an option without the need for life-long anticoagulation. In this review, we introduce the concept of preventing both ischemic and hemorrhagic strokes in AF patients through accurate AF diagnosis and stratification of both embolic and ICH risks. LAAC can be considered in patients at higher hemorrhagic risks while warfarin/DOAC use should be individualized in the majority of AF patients at a low risk of bleeding.

Discussion

No takes yet. Share an insight, caveat, or question.

Figures from the paper

Published by Current Neurology and Neuroscience Reports · CC BY

Cite This Study

Gökçal et al. (2018) conducted a review in Atrial Fibrillation. Stroke prevention strategies (DOACs, LAAC, Warfarin) was evaluated. Left atrial appendage closure provides an alternative to life-long anticoagulation for atrial fibrillation patients at high hemorrhagic risk, while direct oral anticoagulants offer a safer alternative to warfarin.

synapsesocial.com/papers/6a7307c7b55d92fe75f5c537 https://doi.org/10.1007/s11910-018-0813-y