What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke and atrial fibrillation (n=242). Intervention: Oral anticoagulation. Primary outcome: Stroke etiology and characteristics.

What question did this study set out to answer?

This study aims to characterize patients with acute ischemic stroke who have atrial fibrillation despite being on oral anticoagulation therapy.

May 8, 2026European Stroke JournalOpen Access

Abstract Number: Esoc2026a2461 Acute Ischemic Stroke in Patients With Atrial Fibrillation Despite Adherence to Appropriate Oral Anticoagulation

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Key result

Appropriate OAC is present in ~26% of patients with AF and acute ischemic stroke.

n=242

Why the study?

Atrial fibrillation causes 20-30% of acute ischemic strokes, and embolic events still occur despite adherence to oral anticoagulants.

Population

242 consecutive inpatients with AIS and AF

Comparison

Adequately dosed and compliant OAC regimen vs non-compliant or inappropriate regimens

Design

Retrospective observational study

Authors

JOJoão Miguel A OliveiraCâmara Municipal de Almada TMTomás MartinsCâmara Municipal de Almada IDInês DominguesCâmara Municipal de Almada

Discussion

Member takes

Implication

Seek concomitant etiologies in AF stroke despite compliant OAC; leaves open secondary prevention strategies pending randomized evidence.

Key Points

This study aims to characterize patients with acute ischemic stroke who have atrial fibrillation despite being on oral anticoagulation therapy.
Retrospective observational study of inpatients with acute ischemic stroke and atrial fibrillation from January 2023 to December 2024.
Analyzed clinical-demographic data, AF characteristics, risk factors, treatment, and stroke aetiological investigation results.
Included 242 patients, with a focus on adherence to oral anticoagulants and stroke causes.
64 out of 242 patients (26.4%) suffered a stroke despite adequate oral anticoagulation therapy.
Aetiological investigations showed that 22% had multiple causes for their stroke, while 18.8% had AF as the sole identified cause with controlled risk factors.
54% of patients had uncontrolled vascular risk factors like hypertension or diabetes.

Study Design

Type

Observational (n=242)

Structured PICO

Population

242 consecutive inpatients with acute ischemic stroke (AIS) and atrial fibrillation (AF), with a focus on 64 patients who suffered a stroke despite an appropriately dosed and compliant oral anticoagulant (OAC) regimen. Median age 82 years, 51.6% female.

Intervention

Appropriately dosed and compliant oral anticoagulant (OAC) regimen (apixaban most common)

Outcome

Etiology of stroke (concomitant causes, other cardioembolic causes, or AF as sole etiology)

Over a quarter of AF patients presenting with acute ischemic stroke are adherent to appropriate oral anticoagulation, and among these, multiple alternative or concomitant etiologies are frequently identified.

Limitations

Not all patients were offered aetiological investigation

Cite This Study

Oliveira et al. (2026) conducted an observational in Acute ischemic stroke and atrial fibrillation (n=242). Oral anticoagulation was evaluated on Stroke etiology and characteristics. Appropriate oral anticoagulation was present in 26.4% of patients with acute ischemic stroke and atrial fibrillation, with multiple etiologies found in 22% of investigated cases.

synapsesocial.com/papers/69fd7ec6bfa21ec5bbf0700b https://doi.org/10.1093/esj/aakag023.1120

Topics

Atrial fibrillation Anticoagulation in AF Persistent AF management

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Abstract Number: Esoc2026a2461 Acute Ischemic Stroke in Patients With Atrial Fibrillation Despite Adherence to Appropriate Oral Anticoagulation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Topics

Abstract Number: Esoc2026a2461 Acute Ischemic Stroke in Patients With Atrial Fibrillation Despite Adherence to Appropriate Oral Anticoagulation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

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Topics

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