Atrial fibrillation management

Anticoagulation is used for long-term secondary prevention following cardioembolic stroke, particularly due to atrial fibrillation (AF). Twenty-seven percent of patients with stroke were admitted with AF in the last National Stroke Audit of Acute Services and a further 6% were identified during the stroke admission. Only 74% of patients with AF were discharged on oral anticoagulation following ischaemic stroke.

Until recently, treatment was usually warfarin, which required monitoring of international normalised ratio (INR) levels. Direct oral anticoagulants (DOACs), which inhibit thrombin and factor Xa, are now available and do not require INR monitoring. DOACs include dabigatran, rivaroxaban, apixaban and edoxaban.

Medication adherence and the need for careful monitoring is a major issue. Anticoagulant therapy is consistently found to be under-used in primary practice.

For current research and evidence-based recommendations see our Clinical Guidelines.