In this video, Professor Rónán Collins discusses the initiation of oral anticoagulants in patients with atrial fibrillation after an acute ischemic stroke or intracranial haemorrhage. He sets the scene by discussing a patient case from Tallaght University Hospital, which highlights the complexity of these patients and the dilemmas healthcare professionals can meet when treating them.
In the context of ischemic stroke (IS), Prof. Collins discusses the detection of suspected atrial fibrillation along with the management options and timing of anticoagulation if atrial fibrillation is present. He discusses factors which would favour earlier initiation of treatment, as well as patients who might benefit from later initiation to avoid further complications such as haemorrhagic transformation.
Regarding patients with atrial fibrillation who have had an intracranial haemorrhage, Prof. Collins discusses the balance of preventing further bleeding while protecting against a future ischemic event. He discusses the available evidence in the area along with factors which support early or late resumption of anticoagulation therapy.
Rónán Collins MD FRCP (Lond) FRCPI FESO- Graduate of University College Cork 1992 and completed his higher medical training in Geriatric Medicine at Trinity College Dublin and the Yorkshire deanery at Leeds UK in 2002. He was appointed consultant in Geriatric and Stroke Medicine Tallaght University Hospital Dublin in 2005 and a clinical associate professor in geriatric medicine in 2017. National PI on ENOS, TICH-2 trials, Blitz-AF and Gloria-AF registries. Director of stroke services at Tallaght 2005-2017, project lead on the successful inaugural Dublin mid-leinster stroke telemedicine project and current Royal College of Physicians National Clinical Lead in Stroke. He is a member of the European Heart Rhythm Association writing group for the ‘Practical guide for oral anticoagulation with NOACS in Atrial Fibrillation ’ and Co-Founder of Stroke Prevention and Atrial Fibrillation Ireland (SPAFI), an interdisciplinary initiative launched in November 2019. A keen fisherman, lover of hurling, environmentalist and a promoter of patient narrative and intergenerational connectivity through arts in health. Special clinical and research interests include stroke, atrial fibrillation, arts in health, dementia & reminiscence and telemedicine.
Consultant Physician in
Geriatric and Stroke Medicine,
Tallaght University Hospital, Dublin