Secondary Stroke Prevention Following Embolic Stroke of Unknown Source in the Absence of Documented Atrial Fibrillation: A Clinical Review.

8 With historical studies demonstrating a reduction in secondary stroke risk from 12% to 4% per year (hazard ratio, 0.34; 95% CI, 0.36–0.79) in patients randomly assigned to receive anticoagulation or placebo following stroke, the risks of delaying anticoagulation in this cohort of patients are likely to be significant. 50 This observation was recently supported in the EAST‐AFNET 4 (Early Rhythm Control Therapy in Patients with Atrial Fibrillation) study, where lower stroke rates were documented in patients receiving early rhythm control compared with usual care (treatment effect hazard ratio, 0.65; 95% CI, 0.44–0.97). 51 Furthermore, a proportion of patients may never develop AF but remain at high risk of embolic stroke attributable to underlying atrial disease in keeping with an atrial cardiomyopathy.

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