Prognosis of Stroke Despite Oral Anticoagulation Treatment

Oral anticoagulants (OACs), including vitamin K antagonists and direct oral anticoagulant (DOAC) medications, are well established for prevention of embolic stroke in patients with atrial fibrillation (AF). Although anticoagulants are associated with a substantial risk reduction, a finite group of patients experience an ischemic stroke despite OAC therapy. Whether these patients have a different prognosis and whether they benefit from switching to a different anticoagulant are two unknown questions. To address these questions, investigators analyzed seven prospective cohort studies with a total of 5413 patients (median age, 78 years; 48% women; median NIH Stroke Scale score, 6; median CHA₂DS₂-VASC score, 5). Patients were classified accordi…