Contrasting with the abundant literature dedicated to
atrial fibrillation (AF) and to the use of new oral
anticoagulants in this setting, very few recent studies have focused on patients with AF-associated
stroke. From November 2010 to March 2011, we conducted a small prospective 4-month study in the
stroke units of Lariboisière and Bicêtre hospitals. Fifty patients with FA and
stroke were included (14% of all
strokes), including 45 patients with
cerebral infarcts (CI), 3 with
transient ischemic attacks (TIA) and 2 with
intracerebral hemorrhage (ICH). The results of this study, together with a review of the sparse relevant literature, underline the following points: these patients tend to be older and more frequently female than in recent clinical trials; TIAs are rare; these patients have numerous vascular risk factors and associated
cerebrovascular diseases such as
atheroma and
leukoaraiosis; CI is often extensive and hemorrhagic; AF is discovered in a
stroke unit in 40% of cases and is paroxystic in 33% of cases, with no consensus on the potential regulation; there is massive underuse of VKA in patients with known AF; rtPA intravenous thrombolysis is frequent; treatment difficulties arise in patients with AF-related CI and a history of ICH; the prognosis of VKA-related ICH is poor; the use of oral
anticoagulants alone or combined with
aspirin is controversial in case of AF associated with severe
atheroma. Patients with AF seen in
stroke units are therefore very different from those seen by cardiologists: they are older and have many vascular risk factors,
stroke, and other cerebrovascular lesions, raising difficult treatment issues owing to the dual risk of embolic recurrence and symptomatic hemorrhagic transformation. In addition,
contraindications to long-term VKA use are frequent. Many of these issues will again be raised with the arrival of new oral
anticoagulants.