Atrial fibrillation is one of the key risk factors for ischaemic stroke. It is therefore very important to recognise and treat atrial fibrillation if it's identified in a patient following a stroke or transient ischaemic attack (TIA).

Management

• following a stroke or TIA it is obviously important to exclude a haemorrhage before starting any anticoagulation or antiplatelet therapy
• for longer-term stroke prevention, NICE Clinical Knowledge Summaries recommend warfarin or a direct thrombin or factor Xa inhibitor
• the timing of when to start depends on whether it is a TIA or stroke
  • following a TIA, anticoagulation for AF should start immediately once imaging has excluded haemorrhage
  • in acute stroke patients, in the absence of haemorrhage, anticoagulation therapy should be commenced after 2 weeks. Antiplatelet therapy should be given in the intervening period. If imaging shows a very large cerebral infarction then the initiation of anticoagulation should be delayed