13 Jul 2023 • Despite the effectiveness of direct oral anticoagulants (DOACs) in preventing stroke in patients with atrial fibrillation (AF), a finite proportion of patients have breakthrough strokes. he optimal antithrombotic strategy for these patients is uncertain. Options include continuing the same DOAC, switching to another DOAC, switching to warfarin, or adding antiplatelet therapy.

In a recent study published in American Academy of Neurology's Journal, the findings suggest that despite the inclination of some clinicians to try a different strategy following a breakthrough stroke, continuing the same DOAC was associated with the lowest stroke rate.

• The study authors conducted a population-based, observational study among all public hospitals in Hong Kong over a 6-year period.
• Patients with strokes while on DOAC therapy were identified and the antithrombotic strategy following the event was recorded.
• Of 2337 patients identified with nonvalvular AF, 71% continued the same DOAC (DOAC-same), 20% switched to another DOAC (DOAC-switch), and 5% switched to warfarin (warfarin switch)
• During a median follow-up period of 16.5 months, the annualized rate of recurrent ischemic stroke was 8.7% in the DOAC-same group, 12.8% in the DOAC-switch group, and 12.6% with conversion to warfarin.
• There was no difference in mortality among the three strategies.

This study provides Class II evidence that in patients with non-valvular atrial fibrillation suffering an ischemic stroke while being treated with a DOAC, continuing treatment with that DOAC is more effective at preventing recurrent ischemic stroke than switching to a different DOAC or to warfarin.

Source: AAN | Read full story