Anticoagulation in patients with acute ischemic stroke and atrial fibrillation--a balance of risks and benefits.

OBJECTIVES: We reviewed the current literature regarding anticoagulation in patients presenting with acute ischemic stroke and atrial fibrillation. METHODS: A systematic literature search was performed using PUBMED. All relevant articles including meta-analysis, original case studies and cross-references from relevant articles were included in this review. RESULTS: Atrial fibrillation is a thrombogenic state and predisposes to acute embolic strokes. Most studies do not show any mortality or morbidity benefit of anticoagulation with unfractionated or low-molecular weight heparins in patients with acute stroke. The relative risk of hemorrhagic transformation of the ischemic stroke is higher than the lowering of stroke due to recurrent embolism. Large infarcts, greater patient age, extensive small vessel disease and uncontrolled hypertension should prompt a further delay in anti-coagulation. CONCLUSION: Avoid anticoagulation with heparins in patients with acute ischemic stroke with atrial fibrillation for 7-10 days. Further studies are needed to delineate when to start oral anticoagulation.