Compared to the normal population, patients with atrial fibrillation are at a significantly enhanced risk for cerebrovascular insults, in particular when the fibrillation is of recent occurrence, chronic rather than paroxysmal, and when it is associated with cardiopathy. Several studies have documented the efficacy of anticoagulation in prevention of cerebrovascular insults. Aspirin may be a valid alternative in young patients without cardiopathy; however, anticoagulation is more effective in patients which have experienced thromboembolism. In elderly patients (over 75 years) the situation is unclear, because the favorable effects of anticoagulation are offset by an increased risk for intracerebral hemorrhage. The treatment must thus be individualized by assessment of a risk/benefit ratio.
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