Key result
DAPT and rivaroxaban fail to prevent acute ischemic stroke in a compliant AF patient.
Why the study?
To report a case highlighting the occurrence of an ischemic stroke despite concurrent treatment with dual antiplatelet therapy and anticoagulation.
Case Report (n=1)
This case highlights that ischemic stroke can still occur in patients receiving aggressive antithrombotic therapy with DAPT and anticoagulation.
Stroke risk persists despite DAPT plus anticoagulation in elderly AF; case reports leave optimal regimens open for study.
Cerebrovascular accidents (CVA) or strokes cause focal neurological deficits, which may be due to rupture or occlusion of blood vessels supplying areas of the brain. Atrial fibrillation (AF) is an independent and significant risk factor for ischemic CVA, mainly via the embolic pathway. This is evident as newly diagnosed patients with AF are typically started on anticoagulation therapy if their CHA2DS2-VASc score is equal to or greater than two. Furthermore, ischemic CVA may occur as a thrombotic phenomenon due to significant vessel atherosclerotic disease involving plaque ulceration and rupture. Such a phenomenon may be curtailed with antiplatelet therapy in at-risk patient populations, particularly as a form of secondary prevention. This case highlights the unfortunate incidence of an ischemic CVA in a patient using dual antiplatelet therapy (DAPT) and anticoagulation.
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Amoda et al. (2021) conducted a case report in Atrial Fibrillation and Acute Ischemic Stroke (n=1). Dual antiplatelet therapy (aspirin and clopidogrel) plus rivaroxaban was evaluated on Occurrence of acute ischemic stroke. A 93-year-old female with atrial fibrillation developed an acute ischemic stroke despite compliance with dual antiplatelet therapy and rivaroxaban.
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