title: Approach to and management of the acute stroke patient with atrial fibrillation: a literature review.
abstract: Stroke remains an increasing worldwide cause of disability and mortality, and it is the second leading cause of death in industrialized countries. Patients with atrial fibrillation form a unique group with increased risk of cardioembolic stroke. Despite the widespread application of the National Institutes of Health stroke scale and guidelines, patients with atrial fibrillation represent a clinically challenging group that deserves a special approach during the acute stroke phase. The mechanism of stroke in these patients is either cardioembolic [especially with an international normalized ratio (INR) < 2.0] or hemorrhagic (especially with INR > 5.0) (Figure 1). Atrial fibrillation with valvular heart disease significantly increases the risk for ischemic stroke. Specifically, patients with mitral stenosis who develop atrial fibrillation increase their risk of cardioembolism by 3 to 7 times. Many patients with atrial fibrillation still develop ischemic or hemorrhagic stroke despite appropriate use of anticoagulation. Prior stroke, transient ischemic attacks, congestive heart failure, hypertension, age > 75, and diabetes mellitus are all well-established risk factors for the development of stroke in patients with atrial fibrillation. The CHADS-2 score is the most widely studied and clinically used method for stratifying patients with nonrheumatic atrial fibrillation. In our review, we present the most recent clinical guidelines and trends for the approach to and management of this patient group.
authors.affiliation: Department of Cardiology, Montreal Heart Institute/University of Montreal, Montreal, Canada. c.marmagiolis@gmail.com
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Marmagkiolis
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Nikolaidis
authors.forename: Themos
authors.initials: T
authors.lastname: Politis
authors.forename: Lawrence
authors.initials: L
authors.lastname: Goldstein
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications*; D015942:Factor VIIa / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000628:therapy; D010949:Plasma; D011994:Recombinant Proteins / Q000627:therapeutic use; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D014812:Vitamin K / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D011994:Recombinant Proteins; D014812:Vitamin K; D014859:Warfarin; D006493:Heparin; C103587:recombinant FVIIa; D015942:Factor VIIa; D001241:Aspirin