An overview of the anticoagulation therapy in ischemic stroke associated with non-valvular atrial fibrillation

Abstract

Atrial fibrillation (AF) significantly contributes to ischemic stroke, which poses a major healthcare challenge due to its significant morbidity and mortality rates. AF increases with age and is a common cause of cardioembolic strokes - a substantial economic and social burden in cerebrovascular disease management. The cornerstone of treatment for AF-related ischemic stroke lies in anticoagulation therapy. Current clinical evidence strongly supports the prolonged administration of warfarin or novel oral anticoagulants (NOACs) in non-valvular AF patients. Considering the practicality and their consistent blood levels in real-world settings, NOACs are opted over traditional therapies by an increasing number of patients; NOACs, such as apixaban and dabigatran showing promising effectiveness and lower bleeding risks compared to warfarin, an increasing number of patients are opting for NOACs over traditional therapies. Recent studies focus on determining the optimal timing for initiating anticoagulation post-stroke, as early intervention potentially reduces recurrence and complications. However, given the diverse clinical presentations of these patients, careful consideration must be given to the timing of anticoagulation initiation and the unique circumstances of special populations, including those with renal impairment, elderly adults, and patients with cerebral microbleeds. This comprehensive review delves into the complexities of anticoagulation management in AF-related ischemic stroke, with a particular focus on the optimal timing of oral anticoagulant initiation and tailored strategies for special patient subgroups. The ultimate goal of this review is to equip healthcare providers with valuable clinical insights and guidance to manage the challenges of AF-related ischemic stroke.

Keywords

Non-valvular atrial fibrillation / Ischemic stroke / Anticoagulation

Acknowledgments

None.

Funding

This study was supported by grants from the National Natural Science Foundation of China (No. 82425101); Beijing Municipal Science and Technology Commission (No.Z2311000048230360); Capital’s Funds for Health Improvement and Research (2022-2-2045; National Key R&D Program of China (2024YFC3044800, 2022YFF1501500, 2022YFF1501501, 2022YFF1501502, 2022YFF1501503, 2022YFF1501504, 2022YFF1501505); Youth Beijing Scholar Program (No.010); Beijing Laboratory of Oral Health (PXM2021_014226_000041); Beijing Talent Project - Class A: Innovation and Development (No. 2018A12); National Ten- Thousand Talent Plan”- Leadership of Scientific and Technological Innovation; National Key R&D Program of China (No. 2017YFC1307900, 2017YFC1307905); Beijing Outstanding Young Scientist Program (No. BJJWZYJH01201910025030).

Conflict of interest

The authors declare they have no competing interests.

Author contributions

Conceptualization: Hui Qu

Writing - original draft: Yicong Wang, Ruinan Zhang

Writing - review & editing: Yilong Wang, Hui Qu

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data

Not applicable.

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