Open AccessDetection and management of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source
Author(s) -
Sanna Tommaso,
Ziegler Paul D.,
Crea Filippo
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22876
Subject(s) - medicine , atrial fibrillation , embolic stroke , aspirin , stroke (engine) , randomized controlled trial , cardiology , intensive care medicine , anticoagulant therapy , ischemic stroke , mechanical engineering , ischemia , engineering
Cryptogenic stroke (CS) and embolic stroke of unknown source (ESUS) represent a major challenge to healthcare systems worldwide. Atrial fibrillation (AF) is commonly found after CS or ESUS. Independent of the mechanism of the index CS or ESUS, detection of AF in these patients offers the opportunity to reduce the risk of stroke recurrence by prescribing an anticoagulant instead of aspirin. The detection of AF may be pursued with different monitoring strategies. Comparison of monitoring strategies should take into account that AF detection rates reported in published studies, and then pooled in meta‐analyses, are not only a function of the monitoring strategy itself, but also depend on patient‐related, device‐related, and study design–related factors. Once AF is found, the decision to anticoagulate a patient should be made on the basis of AF burden and the baseline risk of the patient. Empirical anticoagulation in patients with ESUS and no evidence of AF is an intriguing but still‐unproven strategy and therefore should not be adopted outside of randomized clinical trials.