[Atrial fibrillation as a relevant risk factor for stroke]

Area of Science:

• Cardiology
• Neurology
• Public Health

Context:

• Atrial fibrillation (AF) is a common arrhythmia, increasing ischemic stroke risk fivefold.
• AF impacts cardiac hemodynamics, potentially reducing cerebral blood flow and disturbing cerebral autoregulation during acute stroke.
• The prevalence of atrial fibrillation is rising globally, necessitating effective stroke prevention strategies.

Purpose:

• To explore the potential impact of atrial fibrillation on cerebral circulation autoregulation in acute stroke patients.
• To investigate the link between atrial fibrillation, disturbed cerebral hemodynamics, and increased early mortality or severe outcomes in stroke.
• To highlight the underutilization of oral anticoagulation for stroke prevention in atrial fibrillation patients.

Summary:

• Atrial fibrillation is a major source of emboli causing ischemic stroke and may impair cerebral blood flow regulation.
• This impairment could explain worse outcomes and higher mortality in acute stroke patients with atrial fibrillation compared to those in sinus rhythm.
• Despite guidelines, oral anticoagulant therapy is underprescribed due to physician knowledge gaps and bleeding concerns.

Impact:

• Understanding AF's role in cerebral hemodynamics may lead to improved stroke management protocols.
• Addressing physician knowledge gaps and fears regarding anticoagulation can enhance stroke prevention in AF patients.
• Optimizing antithrombotic prevention in atrial fibrillation is crucial for reducing stroke incidence and improving patient outcomes.