What is your approach to secondary stroke prevention in patients with atrial fibrillation and intracranial stenosis (>70%)?

The patient clearly needs to be on an anticoagulant for stroke prevention with atrial fibrillation and I would choose apixaban. If an antiplatelet is added to the apixaban, the risk of a major bleeding side effect is significantly increased. It is uncertain if apixaban is effective in reducing the r...

Until atrial fibrillation is hopefully managed by conversion, the patient will be on an anticoagulant (apixaban) if the CHADS2 score dictates that. I would also add ASA 81 mg in cases of small vessel disease. If conversion is not feasible, medical management is determined on a case-by-case basis, bu...

Respectfully, I think this approach should require evidence-based justification regarding the following:

1. That cardioversion of AF obviates the need for anticoagulation in patients with a history of stroke.
2. That adding ASA to anticoagulation in patients with AF and ICAD or small vessel disease resu...

COMPASS trial showed that the Xarelto and aspirin arm had a better composite cardiovascular outcome, which was primarily driven by ischemic stroke risk reduction compared to just the Xarelto arm or aspirin arm in those with coronary artery disease.

CAPTIVA trial which is ongoing is looking at three a...

I agree that there is no scientific evidence of benefit in combining antiplatelet therapy for ICAD with anticoagulation for AFIB. However, in cases of a patient with acute stroke due to ICAD who is already on DOAC for AFIB, I feel compelled to add at least baby ASA for a short period, of course, whi...

I do not recall a randomized trial, but I would use the combination only in relatively young patients with severe ICAD.