Key result
Continuing apixaban after breakthrough stroke despite NOAC therapy for NVAF shows 2-month functional improvement.
Why the study?
Up to 20–36% of ischaemic strokes occur in atrial fibrillation patients already on anticoagulation, and cardioembolic ischaemic stroke in NVAF despite NOAC therapy lacks current management guidelines.
Case Report (n=1)
This case highlights the clinical challenge and lack of current management guidelines for patients who suffer a cardioembolic stroke while already on NOAC therapy for NVAF.
Apixaban continuation feasible after breakthrough stroke on NOAC in this case; leaves open evidence-based management strategies for NVAF.
Primary stroke prevention in non-valvular atrial fibrillation (NVAF) is primarily with non-vitamin K oral anticoagulant (NOAC) therapy. However, 20–36% of ischaemic strokes seem to occur in patients with atrial fibrillation while already on anticoagulation. We present a case of an ischaemic stroke in an elderly female in her 70s with medical history significant for hypertension and NVAF. She had a CHA2DS2-VASc score of 3 and was on apixaban for thromboprophylaxis. She presented with neurological deficits consistent with a left middle cerebral artery stroke, confirmed via head imaging; the most likely stroke aetiology was determined to be cardioembolic in the setting of NVAF. She was treated with continuation of her apixaban at the same dosage . She displayed improved function, although with residual expressive aphasia at her 2-month neurology follow-up. Cardioembolic ischaemic stroke in NVAF despite current NOAC therapy does not have current management guidelines.
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Zhen et al. (2024) conducted a case report in Non-valvular atrial fibrillation (NVAF) and ischaemic stroke (n=1). Apixaban was evaluated. Continuation of apixaban in a 70-year-old female who suffered a cardioembolic stroke despite NOAC therapy for NVAF resulted in improved function with residual aphasia at 2 months.
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