Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view

Full Text:


The article evaluates recent perspectives about the role of oral anticoagulants in the secondary prevention of cardioembolic stroke. The timing of prescribing drugs for ischemic stroke and transient ischemic attack is discussed in accordance with current clinical guidelines and the results of clinical trials. The issues of prescribing oral anticoagulants in some problematic situations, such as the elderly and senile age, reperfusion therapy, presence of hemorrhagic transformation, combined atherosclerosis of major head and neck arteries, cerebral microangiopathy, history of intracerebral hemorrhage, cryptogenic stroke, and low patient compliance are considered. Finally, an anticoagulant therapy algorithm in the acute period of cardioembolic stroke is presented.

About the Author

A. A. Kulesh
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation

Aleksey Aleksandrovich Kulesh

Department of neurology and medical genetics

26, Petropavlovskaya St., Perm 614990


1. Seiffge DJ, Werring DJ, Paciaroni M, et al. Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation. Lancet Neurol. 2019 Jan;18(1):117-26. doi: 10.1016/S1474-4422(18)30356-9

2. Hart RG, Coull BM, Hart D. Early recurrent embolism associated with nonvalvular atrial fibrillation: a retrospective study. Stroke. 1983 Sep-Oct;14(5):688-93. doi: 10.1161/01.str.14.5.688

3. Paciaroni M, Agnelli G, Falocci N, et al. Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation: Effect of Anticoagulation and Its Timing: The RAF Study. Stroke. 2015 Aug;46(8):2175-82. doi: 10.1161/STROKEAHA.115.008891

4. Paciaroni M, Agnelli G, Falocci N, et al. Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study. J Neurol. 2016 Feb;263(2):231-7. doi: 10.1007/s00415-015-7957-3

5. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-e467. doi: 10.1161/STR.0000000000000375

6. Ntaios G, Papavasileiou V, Diener HC, et al. Nonvitamin-K-antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and previous stroke or transient ischemic attack: An updated systematic review and meta-analysis of randomized controlled trials. Int J Stroke. 2017 Aug;12(6):589-96. doi: 10.1177/1747493017700663. Epub 2017 Mar 15.

7. Hindricks G, Potpara T, Dagres N, et al; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for CardioThoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021 Feb 1;42(5):373-498. doi: 10.1093/eurheartj/ehaa612

8. Klijn CJ, Paciaroni M, Berge E, et al. Antithrombotic treatment for secondary prevention of stroke and other thromboembolic events in patients with stroke or transient ischemic attack and non-valvular atrial fibrillation: A European Stroke Organisation guideline. Eur Stroke J. 2019 Sep;4(3):198-223. doi: 10.1177/2396987319841187

9. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014 Mar 15;383(9921):955-62. doi: 10.1016/S0140-6736(13)62343-0

10. Granger CB, Alexander JH, McMurray JJ, et al; ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011 Sep 15;365(11):981-92. doi: 10.1056/NEJMoa1107039

11. Parfenov VA, Verbitskaya SV. Secondary prevention of stroke in atrial fibrillation, use of apixaban: ARISTOTLE, AVERROES studies. Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;(2S):7-14. doi: 10.14412/2074-2711-2014-2S-7-14 (In Russ.).

12. Rutherford OW, Jonasson C, Ghanima W, et al. Comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in atrial fibrillation: a nationwide cohort study. Eur Heart J Cardiovasc Pharmacother. 2020 Apr 1;6(2):75-85. doi: 10.1093/ehjcvp/pvz086

13. Coleman CI, Peacock WF, Bunz TJ, Alberts MJ. Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation and Previous Stroke or Transient Ischemic Attack. Stroke. 2017 Aug;48(8):2142-9. doi: 10.1161/STROKEAHA.117.017474

14. Diener HC, Hankey GJ, Easton JD, et al. Non-vitamin K oral anticoagulants for secondary stroke prevention in patients with atrial fibrillation. Eur Heart J Suppl. 2020 Sep 15;22(Suppl I):I13-I21. doi: 10.1093/eur-heartj/suaa104

15. Proietti M, Romanazzi I, Romiti GF, et al. Real-World Use of Apixaban for Stroke Prevention in Atrial Fibrillation: A Systematic Review and Meta-Analysis. Stroke. 2018 Jan;49(1):98-106. doi: 10.1161/STROKEAHA.117.018395

16. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016 Nov;18(11):1609-78. doi: 10.1093/europace/euw295

17. Eun MY, Kim JY, Hwang YH, et al. Initiation of Guideline-Matched Oral Anticoagulant in Atrial Fibrillation-Related Stroke. J Stroke. 2021 Jan;23(1):113-23. doi: 10.5853/jos.2020.03440

18. Warner JJ, Harrington RA, Sacco RL, Elkind MSV. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke. Stroke. 2019 Dec;50(12):3331-2. doi: 10.1161/STROKEAHA.119.027708

19. Steffel J, Collins R, Antz M, et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021 Apr 25:euab065. doi: 10.1093/europace/euab065

20. Seiffge DJ, Traenka C, Polymeris A, et al. Early start of DOAC after ischemic stroke: Risk of intracranial hemorrhage and recurrent events. Neurology. 2016 Nov 1;87(18):1856-62. doi: 10.1212/WNL.0000000000003283

21. Arihiro S, Todo K, Koga M, et al; SAMURAI Study Investigators. Three-month risk-benefit profile of anticoagulation after stroke with atrial fibrillation: The SAMURAI – Nonvalvular Atrial Fibrillation (NVAF) study. Int J Stroke. 2016 Jul;11(5):565-74. doi: 10.1177/1747493016632239

22. Paciaroni M, Agnelli G, Falocci N, et al. Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin-K Oral Anticoagulants (RAF-NOACs) Study. J Am Heart Assoc. 2017 Nov 29;6(12):e007034. doi: 10.1161/JAHA.117.007034

23. Wilson D, Ambler G, Banerjee G, et al; Clinical relevance of Microbleeds in Stroke (CROMIS-2) collaborators. Early versus late anticoagulation for ischaemic stroke associated with atrial fibrillation: multicentre cohort study. J Neurol Neurosurg Psychiatry. 2019 Mar;90(3):320-5. doi: 10.1136/jnnp-2018-318890

24. Yaghi S, Trivedi T, Henninger N, et al. Anticoagulation Timing in Cardioembolic Stroke and Recurrent Event Risk. Ann Neurol. 2020 Oct;88(4):807-16. doi: 10.1002/ana.25844

25. Abdul-Rahim AH, Fulton RL, Frank B, et al; VISTA collaborators. Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy: analysis from VISTA. Eur J Neurol. 2015 Jul;22(7):1048-55. doi: 10.1111/ene.12577

26. Yoshimura S, Uchida K, Sakai N, et al. Safety of Early Administration of Apixaban on Clinical Outcomes in Patients with Acute Large Vessel Occlusion. Transl Stroke Res. 2021 Apr;12(2):266-74. doi: 10.1007/s12975-020-00839-4

27. Alrohimi A, Buck B, Jickling G, et al. Early apixaban therapy after ischemic stroke in patients with atrial fibrillation. J Neurol. 2021 May;268(5):1837-46. doi: 10.1007/s00415-020-10335-2

28. Hong KS, Kwon SU, Lee SH, et al; Phase 2 Exploratory Clinical Study to Assess the Effects of Xarelto (Rivaroxaban) Versus Warfarin on Ischemia, Bleeding, and Hospital Stay in Acute Cerebral Infarction Patients With Non-valvular Atrial Fibrillation (Triple AXEL) Study Group. Rivaroxaban vs Warfarin Sodium in the UltraEarly Period After Atrial Fibrillation-Related Mild Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol. 2017 Oct 1;74(10):1206-15. doi: 10.1001/jamaneurol.2017.2161

29. Butcher KS, Ng K, Sheridan P, et al. Dabigatran Treatment of Acute Noncardioembolic Ischemic Stroke. Stroke. 2020 Apr;51(4):1190-8. doi: 10.1161/STROKEAHA.119.027569

30. Labovitz AJ, Rose DZ, Fradley MG, et al; AREST Investigators. Early Apixaban Use Following Stroke in Patients with Atrial Fibrillation: Results of the AREST Trial. Stroke. 2021 Apr;52(4):1164-71. doi: 10.1161/STROKEAHA.120.030042

31. Mac Grory B, Flood S, Schrag M, et al. Anticoagulation Resumption After Stroke from Atrial Fibrillation. Curr Atheroscler Rep. 2019 May 20;21(8):29. doi: 10.1007/s11883-019-0790-x

32. Vannucchi V, Moroni F, Grifoni E, et al. Management of oral anticoagulation in very old patients with non valvular atrial fibrillation related acute ischemic stroke. J Thromb Thrombolysis. 2020 Jan;49(1):86-93. doi: 10.1007/s11239-019-01972-0

33. Giustozzi M, Acciarresi M, Agnelli G, et al. Safety of Anticoagulation in Patients Treated With Urgent Reperfusion for Ischemic Stroke Related to Atrial Fibrillation. Stroke. 2020 Aug;51(8):2347-54. doi: 10.1161/STROKEAHA.120.030143

34. Yaghi S, Willey JZ, Cucchiara B, et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Quality of Care and Outcomes Research. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017 Dec;48(12):e343-e361. doi: 10.1161/STR.0000000000000152

35. Jaillard A, Cornu C, Durieux A, et al. Hemorrhagic transformation in acute ischemic stroke. The MAST-E study. MAST-E Group. Stroke. 1999 Jul;30(7):1326-32. doi: 10.1161/01.str.30.7.1326

36. Jensen M, Schlemm E, Cheng B, et al. Clinical Characteristics and Outcome of Patients With Hemorrhagic Transformation After Intravenous Thrombolysis in the WAKE-UP Trial. Front Neurol. 2020 Aug 28;11:957. doi: 10.3389/fneur.2020.00957

37. Muscari A, Faccioli L, Lega MV, et al. Predicting hemorrhagic transformation and its timing from maximum cerebral lesion diameter in nonlacunar ischemic strokes. Brain Behav. 2020 Jan;10(1):e01497. doi: 10.1002/brb3.1497

38. Paciaroni M, Agnelli G, Corea F, et al. Early hemorrhagic transformation of brain infarction: rate, predictive factors, and influence on clinical outcome: results of a prospective multicenter study. Stroke. 2008 Aug;39(8):2249-56. doi: 10.1161/STROKEAHA.107.510321

39. Paciaroni M, Bandini F, Agnelli G, et al. Hemorrhagic Transformation in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Time to Initiation of Oral Anticoagulant Therapy and Outcomes. J Am Heart Assoc. 2018 Nov 20;7(22):e010133. doi: 10.1161/JAHA.118.010133

40. Banerjee A, Benedetto V, Gichuru P, et al. Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study. Heart. 2020 Jan;106(2):119-26. doi: 10.1136/heartjnl-2019-315307

41. Ozaki AF, Choi AS, Le QT, et al. Real-World Adherence and Persistence to Direct Oral Anticoagulants in Patients With Atrial Fibrillation: A Systematic Review and MetaAnalysis. Circ Cardiovasc Qual Outcomes. 2020 Mar;13(3):e005969. doi: 10.1161/CIRCOUTCOMES.119.005969

42. Mainbourg S, Cucherat M, Provencher S, et al; META-EMBOL group. Twice- or OnceDaily Dosing of Direct Oral Anticoagulants, a systematic review and meta-analysis. Thromb Res. 2021 Jan;197:24-32. doi: 10.1016/j.thromres.2020.10.011

43. Meya L, Polymeris AA, Schaedelin S, et al. Oral Anticoagulants in Atrial Fibrillation Patients With Recent Stroke Who Are Dependent on the Daily Help of Others. Stroke. 2021 Jul 27:STROKEAHA120033862. doi: 10.1161/STROKEAHA.120.033862

44. Chen LY, Leening MJ, Norby FL, et al. Carotid Intima-Media Thickness and Arterial Stiffness and the Risk of Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study, Multi-Ethnic Study of Atherosclerosis (MESA), and the Rotterdam Study. J Am Heart Assoc. 2016 May 20;5(5):e002907. doi: 10.1161/JAHA.115.002907

45. Wang Z, Korantzopoulos P, Liu T. Carotid Atherosclerosis in Patients with Atrial Fibrillation. Curr Atheroscler Rep. 2019 Nov 29;21(12):55. doi: 10.1007/s11883-019-0808-4. Erratum in: Curr Atheroscler Rep. 2019 Dec 10;22(1):1.

46. Katsi V, Georgiopoulos G, Skafida A, et al. Noncardioembolic Stroke in Patients with Atrial Fibrillation. Angiology. 2019 Apr;70(4):299-304. doi: 10.1177/0003319718791711

47. Aboyans V, Bauersachs R, Mazzolai L, et al. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy. Eur Heart J. 2021 Jul 19:ehab390. doi: 10.1093/eurheartj/ehab390

48. Kulesh AA, Drobakha VE, Shestakov VV. Cerebral small vessel disease: classification, clinical manifestations, diagnosis, and features of treatment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):4-17. doi: 10.14412/2074-2711-2019-3S-4-17 (In Russ.).

49. Kulesh AA, Drobakha VE, Shestakov VV. Sporadic cerebral non-amyloid microangiopathy: pathogenesis, diagnosis, and features of treatment policy. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2018;10(4):13-22. doi: 10.14412/2074-2711-2018-4-13-22 (In Russ.).

50. Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications. Lancet Neurol. 2019;18(7):684-96. doi: 10.1016/S1474-4422(19)30079-1

51. Kulesh AA, Drobakha VE, Shestakov VV. Hemorrhagic manifestations of cerebral amyloid angiopathy: from pathogenesis to clinical significance. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2018;10(3):4-11. doi: 10.14412/2074-2711-2018-3-4-11 (In Russ.).

52. Danchenko IYu, Kulesh AA, Drobakha VE, et al. CADASIL syndrome: differential diagnosis with multiple sclerosis. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2019;119(10-2):128-36. doi: 10.17116/jnevro201911910128 (In Russ.).

53. Kulesh AA, Syromyatnikova LI. Oral anticoagulant therapy in patients after intracerebral hemorrhage. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(3):4-10. doi: 10.14412/2074-2711-2020-3-4-10 (In Russ.).

54. Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration: a united approach. Lancet Neurol. 2013;12:822-38. doi: 10.1016/S1474-4422(13)70124-8

55. Petrault M, Casolla B, Ouk T, et al. Cerebral microbleeds: Beyond the macroscope. Int J Stroke. 2019 Jul;14(5):468-75. doi: 10.1177/1747493019830594. Epub 2019 Feb 12.

56. Graff-Radford J, Lesnick T, Rabinstein AA, et al. Cerebral microbleed incidence, relationship to amyloid burden: The Mayo Clinic Study of Aging. Neurology. 2020 Jan 14;94(2):e190-e199. doi: 10.1212/WNL.0000000000008735

57. Wilson D, Ambler G, Shakeshaft C, et al; CROMIS-2 Collaborators. Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study. Lancet Neurol. 2018;17:539-47. doi: 10.1016/S1474-4422(18)30145-5

58. Marti-Fabregas J, Medrano-Martorell S, Merino E, et al; HERO Study Investigators. MRI predicts intracranial hemorrhage in patients who receive longterm oral anticoagulation. Neurology. 2019;92:e2432-e2443. doi: 10.1212/WNL.0000000000007532

59. Wilson D, Ambler G, Lee KJ, et al; Microbleeds International Collaborative Network. Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies. Lancet Neurol. 2019 Jul;18(7):653-65. doi: 10.1016/S14744422(19)30197-8

60. Casolla B, Cordonnier C. Intracerebral haemorrhage, microbleeds and antithrombotic drugs. Rev Neurol (Paris). 2021 Jan-Feb;177(1-2):11-22. doi: 10.1016/j.neurol.2020.05.008

61. Best JG, Ambler G, Wilson D, et al; Microbleeds International Collaborative Network. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies. Lancet Neurol. 2021 Apr;20(4):294-303. doi: 10.1016/S1474-4422(21)00024-7

62. Tsai CT, Liao JN, Chiang CE, et al. Association of Ischemic Stroke, Major Bleeding, and Other Adverse Events With Warfarin Use vs Non-vitamin K Antagonist Oral Anticoagulant Use in Patients With Atrial Fibrillation With a History of Intracranial Hemorrhage. JAMA Netw Open. 2020 Jun 1;3(6):e206424. doi: 10.1001/jamanetworkopen.2020.6424

63. Guo Z, Ding X, Ye Z, et al. Non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists in atrial fibrillation patients with previous stroke or intracranial hemorrhage: A systematic review and meta-analysis of observational studies. Clin Cardiol. 2021 Jul;44(7):917-24. doi: 10.1002/clc.23647

64. Ntaios G. Embolic Stroke of Undetermined Source: JACC Review Topic of the Week. J Am Coll Cardiol. 2020 Jan 28;75(3):333-40. doi: 10.1016/j.jacc.2019.11.024

65. Tsivgoulis G, Katsanos AH, Köhrmann M, et al. Duration of Implantable Cardiac Monitoring and Detection of Atrial Fibrillation in Ischemic Stroke Patients: A Systematic Review and Meta-Analysis. J Stroke. 2019 Sep;21(3):302-11. doi: 10.5853/jos.2019.01067

66. Grond M, Jauss M, Hamann G, et al. Improved detection of silent atrial fibrillation using 72-hour Holter ECG in patients with ischemic stroke: a prospective multicenter cohort study. Stroke. 2013 Dec;44(12):3357-64. doi: 10.1161/STROKEAHA.113.001884

67. Rubio Campal JM, Garcia Torres MA, Sanchez Borque P, et al. Detecting Atrial Fibrillation in Patients With an Embolic Stroke of Undetermined Source (from the DAF-ESUS registry). Am J Cardiol. 2020 Feb 1;125(3):409-14. doi: 10.1016/j.amjcard.2019.10.050

68. Kitsiou A, Rogalewski A, Kalyani M, et al. Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source during 3 Years of Prolonged Monitoring with an Implantable Loop Recorder. Thromb Haemost. 2021 Jun;121(6):826-33. doi: 10.1055/a-1346-2899

69. Elkind MSV. Atrial Cardiopathy and Stroke Prevention. Curr Cardiol Rep. 2018 Sep 12;20(11):103. doi: 10.1007/s11886-018-1053-0

70. Schnabel RB, Haeusler KG, Healey JS, et al. Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration. Circulation. 2019 Nov 26;140(22):1834-50. doi: 10.1161/CIRCULATIONAHA.119.040267

71. Poli S, Diedler J, Härtig F, et al. Insertable cardiac monitors after cryptogenic stroke a risk factor based approach to enhance the detection rate for paroxysmal atrial fibrillation. Eur J Neurol. 2016 Feb;23(2):375-81. doi: 10.1111/ene.12843

72. Markus A, Valerie S, Mira K. Promising Biomarker Candidates for Cardioembolic Stroke Etiology. A Brief Narrative Review and Current Opinion. Front Neurol. 2021 Feb 25;12:624930. doi: 10.3389/fneur.2021.624930

73. Wasser K, Weber-Krüger M, Gröschel S, et al. Brain Natriuretic Peptide and Discovery of Atrial Fibrillation After Stroke: A Subanalysis of the Find-AFRANDOMISED Trial. Stroke. 2020 Feb;51(2):395-401. doi: 10.1161/STROKEAHA.119.026496

74. Zhang K, Kamtchum-Tatuene J, Li M, Jickling GC. Cardiac natriuretic peptides for diagnosis of covert atrial fibrillation after acute ischaemic stroke: a meta-analysis of diagnostic accuracy studies. Stroke Vasc Neurol. 2021 Mar;6(1):128-32. doi: 10.1136/svn-2020-000440

75. Mekhryakov SA, Kulesh AA, Syromyatnikova LI, Sobyanin KV. Biomarkers of atrial cardiopathy in patients with different pathogenetic subtypes of ischemic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(6):33-41. doi: 10.14412/2074-2711-2020-6-33-41 (In Russ.).

76. Patel K, Mikhael E, Liu M, et al. Anticoagulation Therapy Reduces Recurrent Stroke in Embolic Stroke of Undetermined Source Patients With Elevated Coagulation Markers or Severe Left Atrial Enlargement. Front Neurol. 2021 Jun 7;12:695378. doi: 10.3389/fneur.2021.695378

77. Kamel H, Longstreth WT Jr, Tirschwell DL, et al. The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: Rationale and methods. Int J Stroke. 2019 Feb;14(2):207-14. doi: 10.1177/1747493018799981


For citations:

Kulesh A.A. Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(5):4-13.

Views: 518

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)