Differences of the prognosis between with and without atrial fibrillation after embolic strokes

Abstract

Atrial fibrillation (Af) can be the strongest risk of embolic stroke. Recently, some of the embolic strokes, which showed no embolic source such as Af or atherothrombotic lesion, have been focused on embolic stroke with undetermined source (ESUS). Although the guidelines recommend antiplatelet medication for the treatment of ESUS, clinical trials have been conducted to evaluate the effectiveness of anticoagulants against antiplatelets for ESUS. Therefore, we investigated the difference of outcome of patients between embolic stroke with and without Af, and both were treated with oral anticoagulants after acute ischemic stroke. The results reveal that the prevalence of risks was not different between patients with Af and without Af. The neurological deficit at onset was milder in patients without Af compared with persistent Af patients. The cumulative rate of ischemic stroke recurrence in 1 year was the same between patients with Af and without Af. The cumulative rate of adverse events (any death, brain hemorrhage and stroke recurrence) was lower in patients without Af compared with persistent Af patients. In conclusion, Af negative patients showed a milder neurological deficit at onset and better outcome compared with persistent Af patients, under the treatment of anticoagulants. These findings may suggest the existence of differences of pathological backgrounds between two stroke subtypes.