Antithrombotic therapy in acute ischemic stroke patients with atrial fibrillation

Atrial fibrillation (AF) is an independent risk factor that increases the risk of acute ischemic stroke by five-fold. In addition, it is also a significant predictor of stroke's poor outcome. The aim of this article was to provide an overview on current approach in AF associated stroke prevention and treatment. Oral anticoagulant therapy (OAC) is recommended for stroke prevention in AF patients. This includes either vitamin K antagonists (VKAs) or novel oral anticoagulants (NOACs). In primary prevention, by using risk stratification schemes, clinicians should identify low-risk AF patients who do not require antithrombotic therapy; all others are indicated for OAC. For secondary stroke prevention all AF patients should be offered OAC. The assessment of bleeding risk should also be performed in order to influence modifiable risk factors for bleeding. Intravenous thrombolysis (IVT) can probably be administrated safely in patients given VKAs if the international normalised ratio is less than 1.7, although bleeding risk is slightly raised. Data regarding safety of IVT used in patients on NOAC are very scarce, however, some coagulation parameters could help to identify those patients who might be eligible for thrombolysis. Stroke prevention is central to the management of AF. The use of OAC is recommended for stroke prevention. In the acute stroke phase, if patients are fully anticoagulated, by any medication, then IVT is contraindicated. However, it may be considered in some circumstances if the level of anticoagulation is subtherapeutic.