Direct oral anticoagulants for prevention of recurrent stroke in patients with atrial fibrillation

Abstract

A history of stroke or transient ischemic attack (TIA) in patients with nonvalvular atrial fibrillation (AF) is associated with a two-fold increase in risk of recurrent stroke. Without anticoagulation the annual incidence of recurrent stroke in these patients ranges from 6% to 9% and significantly exceeds this in patients with other risk factors for thromboembolic events. Meta-analysis of randomised clinical trials (RCT) suggested that direct oral anticoagulants (DOAC) are more effective and safe than warfarin and should be preferred treatment in patients with AF and previous stroke/TIA. Several RCTs are investigating optimal timing of (re)initiation of anticoagulation after acute ischemic stroke. Current guidelines suggest that in most patients treatment with anticoagulants may be initiated within 4-14 days after the onset of acute ischemic stroke depending on its severity and infarct size. Aspirin is recommended until oral anticoagulant therapy is initiated.