Anticoagulation Conundrum in Acute Ischemic Stroke with Atrial Fibrillation

   This editorial reviews the clinical dilemma of when to initiate anticoagulation for secondary stroke prevention in patients with atrial fibrillation following acute ischemic stroke. It discusses findings from the ELAN trial, which compared early versus later initiation of direct oral anticoagulants based on stroke severity. The study revealed no major differences in outcomes between timing strategies, though early initiation showed a slight advantage in reducing recurrent ischemic stroke without increasing hemorrhagic complications. The article also considers related trials and ongoing questions around minor hemorrhagic transformation and timing post-reperfusion therapy.

   This editorial reviews the clinical dilemma of when to initiate anticoagulation for secondary stroke prevention in patients with atrial fibrillation following acute ischemic stroke. It discusses findings from the ELAN trial, which compared early versus later initiation of direct oral anticoagulants based on stroke severity. The study revealed no major differences in outcomes between timing strategies, though early initiation showed a slight advantage in reducing recurrent ischemic stroke without increasing hemorrhagic complications. The article also considers related trials and ongoing questions around minor hemorrhagic transformation and timing post-reperfusion therapy.