Neurologists and stroke physicians will be familiar with atrial fibrillation as a major cause of ischaemic stroke, and the role of anticoagulation in preventing cardioembolic stroke. However, making decisions about anticoagulation for individual patients remains a difficult area of clinical practice, balancing the serious risk of ischaemic stroke against that of major bleeding, particularly intracranial haemorrhage. Atrial fibrillation management requires interdisciplinary collaboration with colleagues in cardiology and haematology. Recent advances, especially the now-widespread availability of direct oral anticoagulants, have brought opportunities to improve stroke care while posing new challenges. This article gives an overview of the contemporary diagnosis and management of atrial fibrillation, and the associated evidence base. Where there is uncertainty, we describe our own approach to these areas, while highlighting ongoing research that will likely guide future practice.
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Contributors DJW had the idea for the article and developed the outline with JGB. JGB, RB, MH, AC and DJW wrote the manuscript and are responsible for its content.
Funding DJW receives research funding support from the British Heart Foundation and the Stroke Association. This work was undertaken at University College London Hospitals NHS Foundation Trust/University College London, who received a proportion of funding from the Department of Health’s National Institute for Health Research Biomedical Research Centres funding scheme.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned. Externally peer reviewed by Anthony Pereira, London, UK, and Peter Groves, Cardiff, UK.