Atrial fibrillation is one of the most common cardiac arrhythmias and is a major cause of ischaemic stroke. Recent findings indicate the importance of atrial fibrillation burden (device-detected, subclinical, or paroxysmal and persistent or permanent) and whether atrial fibrillation was known before stroke onset or diagnosed after stroke for the risk of recurrence. Secondary prevention in patients with atrial fibrillation and stroke aims to reduce the risk of recurrent ischaemic stroke. Findings from randomised controlled trials assessing the optimal timing to introduce direct oral anticoagulant therapy after a stroke show that early start (ie, within 48 h for minor to moderate strokes and within 4–5 days for large strokes) seems safe and could reduce the risk of early recurrence. Other promising developments regarding early rhythm control, left atrial appendage occlusion, and novel factor XI inhibitor oral anticoagulants suggest that these therapies have the potential to further reduce the risk of stroke. Secondary prevention strategies in patients with atrial fibrillation who have a stroke despite oral anticoagulation therapy is an unmet medical need. Research advances suggest a heterogeneous spectrum of causes, and ongoing trials are investigating new approaches for secondary prevention in this vulnerable patient group. In patients with atrial fibrillation and a history of intracerebral haemorrhage, the latest data from randomised controlled trials on stroke prevention shows that oral anticoagulation reduces the risk of ischaemic stroke but more data are needed to define the safety profile.

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房颤患者的二级卒中预防：治疗和试验

心房颤动是最常见的心律失常之一，也是缺血性中风的主要原因。最近的研究结果表明了心房颤动负担（设备检测到的、亚临床的或阵发性的、持续性或永久性的）以及房颤是否在中风发作前已知或在中风后诊断对复发风险的重要性。房颤和中风患者的二级预防旨在降低复发性缺血性中风的风险。评估中风后引入直接口服抗凝治疗最佳时机的随机对照试验的结果表明，早期开始（即，轻度至中度中风在 48 小时内，大中风在 4-5 天内）似乎是安全的，并且可以降低风险早期复发。关于早期节律控制、左心耳封堵和新型 XI 因子抑制剂口服抗凝剂的其他有希望的进展表明，这些疗法有可能进一步降低中风风险。尽管接受口服抗凝治疗但仍发生中风的房颤患者的二级预防策略是一个未得到满足的医疗需求。研究进展表明，病因多种多样，正在进行的试验正在研究针对这一弱势患者群体进行二级预防的新方法。对于有心房颤动和脑出血病史的患者，预防卒中的随机对照试验的最新数据表明，口服抗凝药物可降低缺血性卒中的风险，但需要更多数据来确定其安全性。