Atrial fibrillation in stroke patients: facts, numbers and current challenges.
4 affiliations
- 1Department of Neurology, University of Göttingen Medical Centre, Göttingen, Germany.
- 2Department of Neurology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
- 3Department of Cardiology, University Hospital Leipzig, Liebigstraße 20, Haus 4, Leipzig, 04103, Germany. [email protected].
- 4Partner site Göttingen, German Centre for Cardiovascular Research (DZHK), Göttingen, Germany. [email protected].
Abstract
Atrial fibrillation (AF) is a leading, modifiable risk factor for ischaemic stroke, with 20-30% of stroke patients harbouring underlying AF. Management of AF, however, differs substantially depending on clinical context. In ischaemic stroke patients with pre-known AF, direct oral anticoagulants (DOACs) are the cornerstone of secondary prevention, with initiation timing guided by infarct severity following a risk-adapted approach. In patients with no history of AF, prolonged cardiac rhythm monitoring after stroke or transient ischaemic attack improves AF detection rates. However, it remains uncertain whether this translates into a reduced risk of recurrent stroke, with randomised trials such as Find-AF 2 ongoing. Subclinical AF, detected via implantable devices, is associated with an increased stroke risk correlating with arrhythmia burden; recent trials (ARTESiA, NOAH-AFNET 6) suggest that anticoagulation may reduce ischaemic stroke risk in this population, but at the cost of increased bleeding, necessitating individualised decision-making. Particularly challenging are anticoagulation decisions with concomitant cerebral amyloid angiopathy or prior intracerebral haemorrhage (ICH) due to competing risks of thromboembolism and haemorrhage. Recent meta-analyses indicate that resuming DOACs after ICH reduces ischaemic events but significantly raises the risk of recurrent haemorrhage, without clear improvement in net clinical benefit. New treatment options, such as left atrial appendage closure, carotid artery filter systems, factor XIa inhibitors or rhythm control, must demonstrate in adequately powered randomised controlled trials that they can optimise treatment outcomes in this complex and growing patient group. This article summarises some common interdisciplinary neurological and cardiological questions and discusses the most recent evidence on AF-related stroke prevention across various patient groups, highlighting the importance of individualised, multidisciplinary, and imaging-informed decision-making.
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BibTeX
@article{wasser2026atrial,
title = {{Atrial fibrillation in stroke patients: facts, numbers and current challenges.}},
author = {Katrin Wasser and Deborah Bochert and Johanna Rosemarie Leyhe and Marianne Hahn and Sonja Gröschel and Klaus Gröschel and Rolf Wachter},
journal = {Neurological research and practice},
year = {2026},
month = oct,
doi = {10.1186/s42466-026-00538-9},
url = {https://europepmc.org/article/MED/42897704},
note = {CC BY},
}
RIS
TY - JOUR
TI - Atrial fibrillation in stroke patients: facts, numbers and current challenges.
AU - Katrin Wasser
AU - Deborah Bochert
AU - Johanna Rosemarie Leyhe
AU - Marianne Hahn
AU - Sonja Gröschel
AU - Klaus Gröschel
AU - Rolf Wachter
PY - 2026
DA - 2026/10/19
JO - Neurological research and practice
DO - 10.1186/s42466-026-00538-9
UR - https://europepmc.org/article/MED/42897704
AB - Atrial fibrillation (AF) is a leading, modifiable risk factor for ischaemic stroke, with 20-30% of stroke patients harbouring underlying AF. Management of AF, however, differs substantially depending on clinical context. In ischaemic stroke patients with pre-known AF, direct oral anticoagulants (DOACs) are the cornerstone of secondary prevention, with initiation timing guided by infarct severity following a risk-adapted approach. In patients with no history of AF, prolonged cardiac rhythm monitoring after stroke or transient ischaemic attack improves AF detection rates. However, it remains uncertain whether this translates into a reduced risk of recurrent stroke, with randomised trials such as Find-AF 2 ongoing. Subclinical AF, detected via implantable devices, is associated with an increased stroke risk correlating with arrhythmia burden; recent trials (ARTESiA, NOAH-AFNET 6) suggest that anticoagulation may reduce ischaemic stroke risk in this population, but at the cost of increased bleeding, necessitating individualised decision-making. Particularly challenging are anticoagulation decisions with concomitant cerebral amyloid angiopathy or prior intracerebral haemorrhage (ICH) due to competing risks of thromboembolism and haemorrhage. Recent meta-analyses indicate that resuming DOACs after ICH reduces ischaemic events but significantly raises the risk of recurrent haemorrhage, without clear improvement in net clinical benefit. New treatment options, such as left atrial appendage closure, carotid artery filter systems, factor XIa inhibitors or rhythm control, must demonstrate in adequately powered randomised controlled trials that they can optimise treatment outcomes in this complex and growing patient group. This article summarises some common interdisciplinary neurological and cardiological questions and discusses the most recent evidence on AF-related stroke prevention across various patient groups, highlighting the importance of individualised, multidisciplinary, and imaging-informed decision-making.
SN - 2524-3489
ER -