How well do anticoagulants work to prevent stroke in the setting of atrial fibrillation?
All patients with stroke and atrial fibrillation merit consideration for long-term anticoagulation because it reduces ischemic stroke by more than 60%.
Other high-risk groups include those age >75 (especially women), and those with poorly controlled hypertension, diabetes, poor left ventricular function, or recent heart failure.
The CHA 2 DS 2 -VASc risk stratification scheme integrates risk factors to assist in the decision for anticoagulation therapy: the greater the number of risk factors, the higher the risk of stroke.
Stroke or TIA automatically places a patient in the high-risk category, so secondary prevention of stroke in patients with atrial fibrillation should involve oral anticoagulation unless there is a contraindication.
