REVIEW
Oral Anticoagulation in Patients with Acute Stroke and Atrial
Fibrillation
Irina Mihaela ABDULAN1, Maria Magdalena LEON1,2*,
Alexandra MAȘTALERU1, Laura-Cristina IVAN2, Florin MITU1,2,3
1Department of Medical Specialties I, “Grigore T. Popa”
University of Medicine and Pharmacy, 700115 Iasi, Romania
2Clinical Rehabilitation Hospital, 700661 Iasi, Romania
3Academy of Romanian Scientists
Correspondence to: Maria Magdalena Leon, Department of Medical
Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115
Iasi, Romania; email:
leon_mariamagdalena@yahoo.com
Abstract. Introduction. Patients who have experienced acute ischemic
stroke (AIS) and have atrial fibrillation (AF) are often prescribed oral
anticoagulants (OACs) to lower their risk of recurrent stroke or vascular
embolism. This therapy is rarely advised as a preventive measure for reducing
the risk of recurrent ischemic stroke associated with non-valvular atrial AF.
The ideal timing for initiating oral anticoagulation in these patients remains
uncertain. Methods. Research was conducted in the major
medical databases containing articles. The following terms were used: atrial
fibrillation, acute ischemic stroke, oral anticoagulants, stroke recurrence,
and prevention. We excluded studies performed earlier than 10 years since the
medical information was no longer valid in practice. Results. Information
gathered from observational studies and control groups in randomized trials
indicates that the early recurrence rate following an atrial
fibrillation-related ischemic stroke falls within the range of approximately
0.5% to 1.3% per day during the initial two weeks. The research targeted adults
(aged ≥18 years) with AF and a recent ischemic stroke (IS) (occurring
within 72 hours of symptom onset) who satisfied the criteria for and were
amenable to starting treatment with NOACs. Atrial fibrillation encompassed
paroxysmal, persistent, and permanent forms, whether they were pre-existing
conditions or diagnosed during the initial hospitalization. Observational
studies indicate that the risk of recurrent stroke is seven times higher than
the risk of hemorrhagic transformation during the early phase after a recent
stroke. Conclusions. Early prevention treatments are critical
because the acute phase after an ischemic stroke increases the risk of stroke
recurrence. It is critical to balance the possible benefits of early oral
anticoagulation against the dangers of developing intracerebral hemorrhage or
hemorrhagic transformation of the ischemic injury at this critical time.
Keywords: atrial fibrillation, acute ischemic
stroke, oral anticoagulants, stroke recurrence, prevention.
DOI 10.56082/annalsarscimed.2024.1.39
