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Anticoagulation after stroke: persistent uncertainties

Bernhard M Siepen1,2, David J Seiffge1, Urs Fischer1,3

  • 1Department of Neurology, Inselspital University Hospital Bern and University of Bern.

Current Opinion in Neurology
|November 23, 2021
PubMed

Insights

Direct oral anticoagulants (DOACs) are crucial for preventing stroke in atrial fibrillation. Current research addresses uncertainties in timing, stroke causes, and bleeding risks, with ongoing trials promising improved patient management.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Direct oral anticoagulants (DOACs) are standard for stroke prevention in nonvalvular atrial fibrillation.
  • Significant uncertainties persist regarding optimal DOAC use in specific clinical scenarios.

Purpose of the Study:

  • To review current dilemmas in DOAC therapy for stroke prevention.
  • To discuss uncertainties based on recent clinical studies and ongoing trials.

Main Methods:

  • Review of selected studies focusing on DOAC therapy in atrial fibrillation and stroke.
  • Analysis of recent findings from randomized controlled trials and risk stratification scores.

Main Results:

  • Optimal timing for DOAC initiation post-ischemic stroke remains undetermined.
  • Stroke recurrence despite anticoagulation has varied causes, requiring etiological work-up.
  • DOACs showed no benefit in unselected embolic stroke of undetermined source (ESUS) patients; trials are investigating ESUS subgroups.
  • The MICON score aids in stratifying intracranial hemorrhage risk.

Conclusions:

  • Significant uncertainties persist in managing anticoagulation for stroke patients.
  • Ongoing clinical trials are expected to provide new data for improved patient care.
Abstract

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