title: Acute stroke management in patients with known or suspected atrial fibrillation.
abstract: Atrial fibrillation (AF) is an important cause of ischemic stroke, especially in older individuals. Strokes attributed to AF are often large and result in a high rate of fatality. The new oral anticoagulants offer advantages over warfarin in terms of dosing, pharmacokinetic characteristics, and lower rates of intracranial hemorrhage, but pose new management questions for physicians treating these patients. The management of acute stroke is not modified by the presence of AF, but is unique with respect to management of anticoagulation in the hyperacute and acute phases. We will review and discuss acute treatment options in anticoagulated patients with ischemic stroke, anticoagulation discontinuation, and timing of initiation with old and new oral anticoagulants, and managing intracranial hemorrhage in anticoagulated patients. We will end by briefly discussing investigations of stroke patients with suspected cardioembolic stroke.
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1403 29th St NW, Calgary, Alberta, Canada.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Mandzia
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D001777:Blood Coagulation / Q000187:drug effects*; D002986:Clinical Trials as Topic; D019468:Disease Management; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D016903:Drug Monitoring / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D019934:International Normalized Ratio; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D061665:Time-to-Treatment / Q000706:statistics & numerical data
chemical_list: D000925:Anticoagulants