We surveyed neurologists on therapeutic approaches to timing of anticoagulation after stroke in patients with non-valvular atrial fibrillation (NVAF) using an online questionnaire. Various ischemic and hemorrhagic stroke scenarios,with various locations, size, and high risk thrombotic complications were presented and survey respondents were asked to provide post stroke timeframe for TOAC. Practice background, specialty and years of experience of respondents were also recorded.

Majority of participants favored early initiation of OAC in small infarcts. In larger infarcts, or when ischemia was complicated by hemorrhagic transformation, there was an overall trend to delay any initiation of OAC , irrespective of specialty or years of experience. The overt presence of an additional cardiac embolic source such as cardiac thrombus led to earlier timing decisions regarding initiation of OAC.

General practice trends were captured, optimal timing of anticoagulation following acute ischemic stroke in NVAF remains unknown. Further research is warranted to determine optimal timing and anticoagulant selection.