Ischemic stroke prevention in patients with atrial fibrillation and a recent ischemic stroke, TIA, or intracranial hemorrhage: A World Stroke Organization (WSO) scientific statement

Sposato LA, Cameron AC, Johansen MC, Katan M, Murthy SB, Schachter M, B Sur N, Yaghi S, Aspberg S, Caso V, Hsieh CY, Hilz MJ, Nucera A, Seiffge DJ, Sheppard MN, Martins SC, Bahit MC, Scheitz JF, Shoamanesh A (2025)

Publication Type: Journal article, Review article

Publication year: 2025

Journal

DOI: 10.1177/17474930241312649

Abstract

Background: Secondary stroke prevention in patients with atrial fibrillation (AF) is one of the fastest growing areas in the field of cerebrovascular diseases. This scientific statement from the World Stroke Organization Brain & Heart Task Force provides a critical analysis of the strength of current evidence on this topic, highlights areas of current controversy, identifies knowledge gaps, and proposes priorities for future research. Methods: We select topics with the highest clinical relevance and perform a systematic search to answer specific practical questions. Based on the strength of available evidence and knowledge gaps, we identify topics that need to be prioritized in future research. For this purpose, we adopt a novel classification of evidence strength based on the availability of publications in which the primary population is patients with recent (<6 months) cerebrovascular events, the primary study endpoint is a recurrent ischemic stroke, and the quality of the studies (e.g. observational versus randomized controlled trial). Summary: Priority areas include AF screening, molecular biomarkers, AF subtype classification, anticoagulation in device-detected AF, timing of anticoagulation initiation, effective management of breakthrough strokes on existing anticoagulant therapy, the role of left atrial appendage closure, novel approaches, and antithrombotic therapy post-intracranial hemorrhage. Strength of currently available evidence varies across the selected topics, with early anticoagulation being the one showing more consistent data. Conclusion: Several knowledge gaps persist in most areas related to secondary stroke prevention in AF. Prioritizing research in this field is crucial to advance current knowledge and improve clinical care.

Authors with CRIS profile

Involved external institutions

Hospital Moinhos de Vento Brazil (BR) INECO Neurociencias Oroño Argentina (AR) Charité - Universitätsmedizin Berlin Germany (DE) Western University Canada (CA) Cornell University United States (USA) (US) Piedmont Healthcare United States (USA) (US) Brown University United States (USA) (US) Danderyds sjukhus Sweden (SE) University of Glasgow United Kingdom (GB) Johns Hopkins Hospital United States (USA) (US) Universitätsspital Basel Switzerland (CH) University of Miami United States (USA) (US) Università degli Studi di Perugia Italy (IT) McMaster University Canada (CA) Sin-Lau Christian Hospital / 新樓醫院 Taiwan (TW) Ospedale Fabrizio Spaziani Italy (IT) Inselspital, Universitätsspital Bern Switzerland (CH) St George's, University of London (SGUL) / St George's Hospital Medical School United Kingdom (GB)

How to cite

APA:

Sposato, L.A., Cameron, A.C., Johansen, M.C., Katan, M., Murthy, S.B., Schachter, M.,... Shoamanesh, A. (2025). Ischemic stroke prevention in patients with atrial fibrillation and a recent ischemic stroke, TIA, or intracranial hemorrhage: A World Stroke Organization (WSO) scientific statement. International Journal of Stroke. https://doi.org/10.1177/17474930241312649

MLA:

Sposato, Luciano A., et al. "Ischemic stroke prevention in patients with atrial fibrillation and a recent ischemic stroke, TIA, or intracranial hemorrhage: A World Stroke Organization (WSO) scientific statement." International Journal of Stroke (2025).

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