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Detection and Management of Atrial Fibrillation in Patients with Stroke or TIA in Clinical Practice

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Cardiac Arrhythmias

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Abstract

Atrial fibrillation (AF) is the most common condition of cardioembolic stroke, and anticoagulation is the treatment generally indicated for secondary prevention and in some cases for primary prevention. The prevalence of AF is strongly associated with increasing age, rising to 5 % in people older than 65 years and to nearly 10 % in those aged 80 years. AF increases the risk of stroke four- to fivefold across all age groups, accounting for 10–15 % of all ischemic strokes and nearly 25 % of strokes in people older than 80 years. Stroke-prone patients are reliably identified by a CHADS2 score >3, and they have an average risk of 5.5 strokes per 100 patient-years on aspirin. Dose-adjusted oral anticoagulation (international normalized ratio [INR], 2.0–3.0) with vitamin K antagonists is highly efficient in reducing the risk of ischemic stroke in AF patients with moderate to high risk of stroke and superior to antiplatelet agents. However, in clinical practice only about 50–70 % of AF patients with the indication receive stroke prevention with vitamin K antagonists. Moreover, even in clinical trials, warfarin-anticoagulated patients are in the therapeutic range only about 65 % of the time. Anticoagulation therapy’s associated risk of hemorrhage and cumbersome monitoring requirements have encouraged the investigation of alternative therapies for individuals with AF. Recently published data suggest that new anticoagulants including the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban and apixaban are equivalent or even superior to warfarin in preventing stroke or systemic embolism in the setting of AF. There are data showing a trend toward reduction in all-cause mortality, while the most recent randomized trial demonstrated a clear reduction in the risk of death. Therefore, patients with ischemic stroke or TIA of unknown etiology should be studied for paroxysmal AF. This condition is clearly associated with subsequent stroke risk and should be treated with anticoagulants.

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Authors and Affiliations

  1. Cerebrovascular Diseases Unit, Department of Neurology, Hospital Universitari Mútua Terrassa, Pl. Dr Robert, 5, 08221, Terrassa, Barcelona, Spain

    Jerzy Krupinski MD, PhD, DsC, Jorge de Francisco MD & Sonia Huertas MD

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  1. Jerzy Krupinski MD, PhD, DsC
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  2. Jorge de Francisco MD
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  3. Sonia Huertas MD
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Correspondence to Jerzy Krupinski MD, PhD, DsC .

Editor information

Editors and Affiliations

  1. Department of Cardiology, Center Hospitalier Coutances, Coutances, France

    Ambrose S. Kibos

  2. Department of Internal Medicine Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Bradley P. Knight

  3. Division of Cardiology, McGill University Health Center, Montreal, Québec, Canada

    Vidal Essebag

  4. Department of Cardiology, Miami Children's Hospital, Miami, Florida, USA

    Steven B. Fishberger

  5. School of Biology, Chemistry and Health, Manchester Metropolitan University, Manchester, United Kingdom

    Mark Slevin

  6. “Acad. Vasile Candea” Emergency Clinical Center for Cardiovascular Diseases, “Carol Davila” University of Medicine and Pharmacy, “Titu Maiorescu” University Faculty of Medicine,, Bucharest, Romania

    Ion C. Țintoiu

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Krupinski, J., de Francisco, J., Huertas, S. (2014). Detection and Management of Atrial Fibrillation in Patients with Stroke or TIA in Clinical Practice. In: Kibos, A., Knight, B., Essebag, V., Fishberger, S., Slevin, M., Țintoiu, I. (eds) Cardiac Arrhythmias. Springer, London. https://doi.org/10.1007/978-1-4471-5316-0_17

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