The safety and bene t of OAC in acute stroke have not been established. Early anticoagulation (ie, in the rst few days) might increase the risk of symptomatic ICH, including hemorrhagic transformation of the infarct (estimated at approximately 1% per day313 ), leading to clinical uncertainty about when to start anticoagulation. Studies reported an 8% to 10% risk of recurrent ischemic stroke and a 2% to 4% risk of symptomatic ICH within 90 days of AF-related ischemic stroke.314,315 Current Uncertainty Regarding Optimal Timing of Anticoagulation: Current guidelines do not provide clear recommendations on the timing of OAC after acute AF-related stroke. US guidelines suggest that TABLE ] Summary of Studies of Periprocedural Anticoagulation for Catheter Ablation of AF and Implantation of Cardiac Electronic Implantable Devices Trial Population Interventions Results COMPARE Catheter ablation of AF N Uninterrupted warfarin vs interrupted warfarin with low-molecular weight bridging Signi cant reduction in stroke vs TIA vs and minor bleeding with uninterrupted warfarin VENTURE-AF Catheter ablation of AF N Uninterrupted rivaroxaban vs uninterrupted VKA No difference in overall low incidence of major bleeding or thromboembolic events RE-CIRCUIT Catheter ablation of AF N Uninterrupted dabigatran vs uninterrupted warfarin Signi cant reduction in major bleeding events with dabigatran vs BRUISE-CONTROL Pacemaker or de brillator implantation N Uninterrupted warfarin vs interrupted warfarin with heparin bridging Signi cant reduction in pocket hematoma vs BRUISE-CONTROL Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial; COMPARE Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation; RE-CIRCUIT Randomized Evaluation of Dabigatran Etexilate Compared to Warfarin in Pulmonary Vein Ablation: Assessment of an Uninterrupted Periprocedural Anticoagulation Strategy trial; VENTURE-AF a randomized, open-label, active-controlled multicenter study to evaluate the safety of rivaroxaban and vitamin K antagonists in subjects undergoing catheter ablation for atrial brillation. 