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Updated: Jul 5, 2025

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Characteristics of Ischemic Stroke Despite Oral Anticoagulant Use For Atrial Fibrillation

Marie-Christine Dubé1,2, Célina Ducroux1,2, Nicole Daneault1,2,3

  • 1Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|January 17, 2024
PubMed

Insights

Many patients experience ischemic stroke despite oral anticoagulation (OAC). Suboptimal OAC treatment and adherence are common, highlighting the need for improved management strategies for stroke prevention.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Atrial fibrillation increases stroke risk, managed by oral anticoagulation (OAC).
  • A significant residual stroke risk persists even with OAC therapy.
  • Understanding causes of stroke despite OAC is crucial for improving patient outcomes.

Purpose of the Study:

  • To analyze the causes of acute ischemic stroke in patients receiving OAC.
  • To identify common factors contributing to stroke events in this population.
  • To inform strategies for enhanced secondary stroke prevention.

Main Methods:

  • Single-center retrospective analysis.
  • Inclusion of patients with acute ischemic stroke on OAC.
  • Evaluation of OAC treatment appropriateness, adherence, and interruption.

Main Results:

  • Suboptimal OAC treatment was prevalent (30%), including inappropriate dosing (17%) and non-adherence (13%).
  • OAC interruption (14.5%) and competing stroke mechanisms (11.0%) were identified.
  • Undetermined breakthrough stroke accounted for 44.5% of cases.

Conclusions:

  • Easily modifiable factors contribute significantly to ischemic strokes in patients on OAC.
  • Improving OAC compliance through appropriate dosing and management is essential.
  • Enhanced guideline-based management of risk factors and periprocedural OAC is vital for secondary stroke prevention.

Keywords:
Acute strokeanticoagulationtreatment failure

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