What is the best approach to reduce the risk of recurrent stroke in patients with AF and stroke or TIA?
The best approach to reduce the risk of recurrent stroke in patients with AF and stroke or TIA is to initiate anticoagulation treatment. In patients at high risk of hemorrhagic conversion, it may be reasonable to delay initiation of anticoagulation beyond 14 days. In patients with contraindications for lifelong anticoagulation but can tolerate at least 45 days, it may be reasonable to consider percutaneous closure of the left atrial appendage with the Watchman device to reduce the chance of recurrent stroke. In those with low risk for hemorrhagic conversion, it may be reasonable to initiate anticoagulation 2-14 days after the index event. In patients with end-stage renal disease or on dialysis, warfarin or apixaban (dose adjusted if indicated) may be used for anticoagulation to reduce the chance of recurrent stroke.