Secondary prevention of stroke in patients with atrial fibrillation: what every neurologist should know

Abstract

THE BOTTOM LINE The bottom line for neurologists is that atrial fibrillation (AF) patients who have had an ischaemic stroke or transient ischaemic attack (TIA) are at high risk of recurrent stroke and should be treated long-term with adjusted-dose warfarin (target INR = 2.5) for secondary prevention, provided it can be given safely and the blood pressure well controlled. For acute management, give aspirin until therapeutic anticoagulation is achieved. Please glance quickly at the attractive figures and illuminating tables, and then skip to the next article unless you want more detail! SOME HISTORY By the early 1980s, it was clear from cohort, case-control and autopsy studies that non-valvular AF (i.e. not associated with mitral valvular disease) was a strong, independent risk factor for ischaemic stroke. Based on the presumed pathogenesis of thrombus forming in relatively static blood in the left atrial appendage and then embolizing to the brain (Fig. 1)