Galea, Roberto; Seiffge, David; Räber, Lorenz (2023). Atrial Fibrillation and Ischemic Stroke despite Oral Anticoagulation. Journal of clinical medicine, 12(18) MDPI 10.3390/jcm12185784
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Patients with atrial fibrillation (AF) experiencing ischemic stroke despite oral anticoagulation (OAC), i.e., breakthrough strokes, are not uncommon, and represent an important clinical subgroup in view of the consistently high risk of stroke recurrence and mortality. The understanding of the heterogenous potential mechanism underlying OAC failure is essential in order to implement specific therapeutic measures aimed at reducing the risk of recurrent ischemic stroke. However, due to the incomplete comprehension of this phenomenon and the limited available data, secondary stroke prevention in such high-risk patients represents a clinical dilemma. There are several available strategies to prevent ischemic stroke recurrence in AF patients with breakthrough stroke in the absence of competing causes unrelated to AF, and these include continuation or change in the type of OAC, addition of antiplatelet therapy, left atrial appendage closure, or any combination of the above options. However, due to the limited available data, the latest guidelines do not provide any specific recommendations about which of the above strategies may be preferred. This review describes the incidence, the clinical impact and the potential mechanisms underlying OAC failure in AF patients. Furthermore, the evidence supporting each of the above therapeutic options for secondary stroke prevention and the potential future directions will be discussed.
Item Type: |
Journal Article (Review Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology 04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Galea, Roberto, Seiffge, David Julian, Räber, Lorenz |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2077-0383 |
Publisher: |
MDPI |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
02 Oct 2023 15:11 |
Last Modified: |
02 Oct 2023 15:20 |
Publisher DOI: |
10.3390/jcm12185784 |
PubMed ID: |
37762726 |
Uncontrolled Keywords: |
OAC failure breakthrough strokes ischemic stroke left atrial appendage closure stroke under OAC |
BORIS DOI: |
10.48350/186762 |
URI: |
https://boris.unibe.ch/id/eprint/186762 |
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