Quand debuter un traitement anticoagulant a la phase aigue d'un accident vasculaire cerebral associe a une fibrillation atriale ? When to introduce anticoagulation for atrial fibrillation on stroke acute phase?

摘要

Atrial fibrillation is associated with a 5 fold increase risk of cerebral infarction. Secondary prevention is based on anticoagulation. Decision-making for oral anticoagulation on stroke acute phase, needs to balance the risk of stroke recurrence against the risk of major bleeding, based on scores validated in several studies. In the case of ischemic stroke, it is recommended to consider the risk of hemorrhagic transformation depending on the infarct size. Regarding intracerebral hemorrhage, it is reasonable to distinct two different situations. Hypertensive arteriolopathy is the most common cause for deep hematoma and is associated with a low risk for bleeding recurrence (2% per year). Whereas cerebral amyloid angiopathy is a frequent cause of lobar hemorrhage, and is associated with a high risk for bleeding recurrence (15% per year). In the absence of randomized studies guiding the therapeutic approach, we follow the current guidelines of the AHA and ERHA. ? 2016 Elsevier Masson SAS. Tous droits reserves.