Acute embolic stroke in a patient with atrial fibrillation after electroconvulsive therapy

Although patients with atrial fibrillation (AF) have an increased risk of embolic stroke, some clinicians hesitate to provide anticoagulation therapy for these patients during electroconvulsive therapy (ECT), which is widely applied for the treatment of intractable depression, bipolar disorder, and catatonic schizophrenia, because of potential intracerebral hemorrhage. We report on a 77-year-old female depressive patient with AF treated with aspirin but not on anticoagulation therapy because of poor compliance who developed embolic stroke 1 day after the last ECT. The CHADS₂ score of this patient was 2 and included the age and hypertension. The present case suggests that anticoagulation therapy should be considered for patients with obvious risks of embolic stroke when they are subjected to ECT.