Background and Aims
Secondary prevention of ischemic stroke includes, according to current guidelines antiplatelet or anticoagulant therapy. In practice, antiplatelet therapy is recommended in an undertermined cause of stroke until cardioembolism is clearly demonstrated, primarily by detection of atrial fibrillation (AF). In our communication, we focused on the detection of AF in patients from the TROMB study.
Methods
Patients from the TROMB study were included in the retrospective analysis, from whom a thrombus/embolus was obtained during mechanical thrombectomy as part of the acute treatment of ischemic stroke. The patients were examined for AF during acute hospitalization and subsequently by means of an Holter ECG examination (for a duration of days to 3 weeks).
Results
90 consecutive patients were included in the TROMB study between 2020/2021. Of these, 57 patients (63.3%) were diagnosed with AF. Only in 60 patients was AF known/detected or treated with a long-term (3 week) Holter ECG (57 AF, 95%). With the inclusion of a 1-3 day Holter ECG, 70 patients (57 AF, 81.4%) were examined. Twenty patients could not be treated for various reasons (early death, severe disability/mRS 5/, etc.).
Conclusion
AF is present in patients with ischemic stroke in large vessel occlusion (LVO) and is usually its unequivocal cause. The high incidence of AF leads us to consider whether anticoagulant therapy should be used as part of secondary prevention in cryptogenic LVO stroke instead of the currently recommended antiplatelet therapy. This should be used until the time of thorough investigation of the presence of AF.