Stroke remains a major cause of death and disability. Despite the recent advances in acute stroke treatment, the most effective way to avoid stroke-related mortality and disability is not treatment, but prevention.
As most severe ischaemic strokes are related to cardioembolism in patients with atrial fibrillation (AF), the cornerstone of successful stroke prevention is oral anticoagulation (OAC). Long-term OAC carries an inherent risk of bleeding complications.
The longer OAC is used, the higher is the cumulative risk of bleeding. In most patients with AF, OAC should be given permanently unless severe bleeding occurs.