Stroke prevention in atrial fibrillation

Oral anticoagulation therapy has reduced the risk of ischaemic stroke and improved the outcomes for patients with atrial fibrillation considerably. The emergence of the non-vitamin K oral anticoagulants as alternatives to vitamin K antagonists has significantly changed the practice of stroke prevention in atrial fibrillation. As the main complication with antithrombotic therapy is bleeding, physicians should always balance the risk of ischaemic stroke against intracranial haemorrhage and intervene where appropriate to reduce both risks.

Syncope: to admit or not to admit

Syncope is one element of the broader issue of ‘transient loss of consciousness’, but is nevertheless a very common clinical problem. Emergency department physicians and general practitioners are often the first physicians to evaluate the patient. After ensuring that any serious injury is treated, the most important task is to decide whether to admit patients to hospital. Physicians usually take the ‘safe’ approach and, as a result, admit both high- and intermediaterisk patients to hospital.