Do you add antiplatelet medications to patients already on anticoagulation for atrial fibrillation if they have a stroke due to a competing etiology?

Adding antiplatelet therapy to anticoagulation in patients with atrial fibrillation and a noncardioembolic stroke has not shown a clear benefit and definitely increases bleeding risk. Okazaki et al., PMID 41051787 did not find a benefit and increased bleeding risk. An exception might be in acute MI ...

I agree with the prior answer. To add to the discussion, where my approach differs is when the workup clearly points to the vascular pathology as the culprit rather than a cardioembolic source. If a patient with atrial fibrillation has an intracranial plaque rupture obvious on angiogram during throm...

I tend not to add antiplatelet medication because the overall data for anticoagulation plus antiplatelet therapy usually demonstrates significantly increased hemorrhage risk, which tends to outweigh any ischemic stroke prevention. Overall, however, the data is not great. People may cite the COMPASS ...