Background

Optimal timing of oral anticoagulation (TOAC) in acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) is unknown. The risk of recurrent ischemic events when treatment is delayed is often weighed against that of hemorrhagic transformation (HT) when anticoagulation is started in the subacute phase, especially in moderate to large infarctions. Despite substantial evidence for the benefit of oral anticoagulation (OAC) in reducing stroke recurrence, current nationally recognized practice guidelines do not provide clear recommendations on the TOAC after AF-related AIS.

Materials and Methods

We surveyed neurologists on therapeutic approaches to timing of anticoagulation after stroke in patients with AF (without moderate or severe mitral stenosis or a mechanical heart valve) using an online questionnaire. Several ischemic and hemorrhagic stroke scenarios with various stroke sizes, locations, and high-risk thrombotic complications were presented, and survey respondents were asked to provide post-stroke timeframe for TOAC. Practice background, specialty and years of experience of respondents were recorded.

Results

Majority of participants favored early initiation of OAC in small infarcts. In moderate to larger infarct burden, or when ischemia was complicated by HT, there was an overall trend to delay any initiation of OAC, irrespective of specialty or years of experience. The overt presence of an additional cardiac embolic source such as cardiac thrombus led decisions for early anticoagulation.

Conclusion

Although general practice trends were captured, optimal TOAC following AIS in AF remains unknown. Further research is warranted to determine optimal timing and anticoagulant selection.

中文翻译：

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非瓣膜性心房颤动患者中风后抗凝治疗的时机评估提供者实践

背景

心房颤动 (AF) 患者急性缺血性卒中 (AIS) 口服抗凝 (TOAC) 的最佳时机尚不清楚。当在亚急性期开始抗凝治疗时，尤其是在中度至大面积梗塞中，延迟治疗时复发性缺血事件的风险通常与出血转化 (HT) 的风险进行权衡。尽管有大量证据表明口服抗凝剂 (OAC) 可减少卒中复发，但目前国家认可的实践指南并未对 AF 相关 AIS 后的 TOAC 提供明确建议。

材料和方法

我们使用在线问卷调查了神经科医生关于 AF 患者（无中度或重度二尖瓣狭窄或机械心脏瓣膜）卒中后抗凝治疗时机的治疗方法。介绍了几种缺血性和出血性中风情况，具有不同的中风大小、位置和高危血栓并发症，并要求调查受访者提供 TOAC 的中风后时间框架。记录受访者的实践背景、专业和年限。

结果

大多数参与者赞成在小梗塞中尽早启动 OAC。在中等至较大的梗塞负担中，或当缺血并发 HT 时，无论专业或经验如何，都存在延迟任何 OAC 启动的总体趋势。其他心脏栓塞源（如心脏血栓）的明显存在导致了早期抗凝治疗的决定。

结论

尽管捕获了一般实践趋势，但 AF 中 AIS 后的最佳 TOAC 仍然未知。需要进一步研究以确定最佳时机和抗凝剂选择。