Publication:
Atrial Fibrillation for the Neurologist: Preventing both Ischemic and Hemorrhagic Strokes.

Date
2018-02-05T21:00:00Z
Authors
Gokcal, Elif
Pasi, Marco
Fisher, Marc
Gurol, M Edip
Journal Title
Journal ISSN
Volume Title
Publisher
Research Projects
Organizational Units
Journal Issue
Abstract

This review aims to help neurologists managing atrial fibrillation (AF) patients who had an ischemic stroke and/or with intracranial hemorrhage (ICH) markers, therefore at high embolic/hemorrhagic risks.


Implantable loop recorders have substantially improved the accuracy of AF detection. Recent research yielded a set of powerful neuroimaging markers that can stratify ICH risk. Direct oral anticoagulants (DOAC) are easier to use with a lower ICH risk than warfarin in a general AF population. Finally, the FDA-approved left atrial appendage closure (LAAC) with the WATCHMAN device provides an option without the need for life-long anticoagulation. In this review, we introduce the concept of preventing both ischemic and hemorrhagic strokes in AF patients through accurate AF diagnosis and stratification of both embolic and ICH risks. LAAC can be considered in patients at higher hemorrhagic risks while warfarin/DOAC use should be individualized in the majority of AF patients at a low risk of bleeding.

Description
Keywords
Atrial fibrillation, Intracerebral hemorrhage, Ischemic stroke, Left atrial appendage closure
Citation
Sustainable Development Goals