Secondary stroke prevention in atrial fibrillation: Indications, risks, and benefits

Patients with nonrheumatic atrial fibrillation (NRAF) and a recent transient ischemic attack (TIA) or nondisabling ischemic stroke have a high risk of stroke recurrence of about 12%, per year. Two randomized clinical trials have shown that oral anticoagulant therapy reduces the risk by two thirds, very similar to the benefit in primary prevention. The optimal intensity is INR 2.0-3.0. In case of a contraindication to AC, aspirin and ibuprofen are safe, but less effective, alternatives. During the first 2 weeks following AF-related major stroke, the benefit of subcutaneous heparin is offset by a higher risk of secondary cerebral bleeding, and therefore cannot be recommended, at present, during that period. The risk of stroke recurrence can be predicted by means of easily available clinical information.

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