Anticoagulation Conundrum in Acute Ischemic Stroke with Atrial Fibrillation

Decades ago, before the days of thrombolysis for ischemic stroke, many patients with acute ischemic stroke routinely received anticoagulation therapy. This practice is now less common, and the question is now when to start anticoagulation for long-term prevention of secondary stroke, particularly in patients with atrial fibrillation. When is the risk of a hemorrhagic complication of anticoagulation balanced by the beneficial effect of prevention of recurrent stroke? Early randomized trials focused on rapid anticoagulation with the use of heparin or low-molecular-weight heparin — agents that were associated with a risk of hemorrhage.1 In the past decade, observational studies of direct . . .