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Stroke in Atrial Fibrillation and Other Atrial Dysrhythmias

  • Stroke (DL Tirschwell, Section Editor)
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Abstract

Purpose of Review

Atrial fibrillation (AF) is a major risk factor for systemic embolism and ischaemic stroke. Furthermore, AF-related strokes are associated with higher mortality, greater disability, longer hospital stays and lower rates of hospital discharge than strokes caused by other reasons. The aim of this review to summarise the existing evidence on the association of AF with ischemic stroke and provide insights on the pathophysiological mechanisms and the clinical management of patients with AF in order to reduce the burden of ischemic stroke.

Recent Findings

Beyond Virchow’s triad, several pathophysiological mechanisms associated with structural changes in the left atrium, which may precede the identification of AF, may contribute to the increased risk of arterial embolism in AF patients. Individualised thromboembolic risk stratification based on CHA2DS2-VASc score and clinically relevant biomarkers provides essential tool towards a personalised holistic approach in thromboembolism prevention. Anticoagulation remains the cornerstone of stroke prevention moving from vitamin K antagonists (VKA) to safer non-vitamin K direct oral anticoagulants in the majority of AF patients. Despite the efficacy and safety of oral anticoagulation, still the equilibrium between thrombosis and haemostasis in AF patients remains suboptimal and future directions in anticoagulation and cardiac intervention may provide novel treatment options in stroke prevention.

Summary

This review summarises the pathophysiologic mechanisms of thromboembolism, aiming the current and potential future perspectives in stroke prevention in AF patients.

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Authors and Affiliations

  1. Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK

    Hizir Ozdemir, Dimitrios Sagris, Gregory Y. H. Lip & Azmil H. Abdul-Rahim

  2. Department of Internal Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece

    Dimitrios Sagris

  3. Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK

    Gregory Y. H. Lip & Azmil H. Abdul-Rahim

  4. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Gregory Y. H. Lip

  5. Stroke Division, Department of Medicine for Older People, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Rainhill, UK

    Azmil H. Abdul-Rahim

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Dr Sagris reports receiving research support by the ESC council on Stroke. Prof Lip reports being a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are received personally. All other authors declare no competing interests.

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Ozdemir, H., Sagris, D., Lip, G.Y.H. et al. Stroke in Atrial Fibrillation and Other Atrial Dysrhythmias. Curr Cardiol Rep 25, 357–369 (2023). https://doi.org/10.1007/s11886-023-01862-1

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