HELSINKI, Finland — The pros and cons of early vs late initiation of a direct oral anticoagulant (OAC) after acute ischemic stroke in the setting of atrial fibrillation (AF) for secondary prevention was the topic of a lively debate at the Congress of the European Academy of Neurology 2024. In an audience vote prior to the discussion, 77% voted yes to early anticoagulation, whereas 23% opted for no early anticoagulation. Arguing for early anticoagulation, Urs Fischer, MD, professor of neurology at University Hospital Basel, Switzerland, told delegates that neurologists face a dilemma after stroke in patients with AF. “We are scared of ischemic recurrence [if we don’t start oral anticoagu
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