Choice of Oral Anticoagulant: Outcomes in Atrial Fibrillation Patients Post-Stroke Despite Direct Oral Anticoagulant Use

BackgroundFor patients with atrial fibrillation (AF) having ischemic stroke or transient attack (TIA) despite taking direct oral anticoagulants (DOAC), the optimal strategy for ongoing anticoagulation is unknown.MethodsUsing provincial administrative databases in Alberta, Canada, we compared anticoagulant use before/after breakthrough stroke/TIA and assessed recurrence of bleeding, consideration medication adherence. Adherence was defined as proportion days covered (PDC) being >80%.ResultsAmongst 985 patients, median age 80 (13) years a mean CHADS2 score 1.7+1 prior to index event. Patients were followed 643 (836) days. Following event, 623 (63%) filled same DOAC regimen, 83 (8%) different dose, 155 (16%) switched agents, 51 (5%) warfarin 73 (7%) no OAC. who kept regimen more commonly had TIA events (59%); that changed dose drug often (55-78%). During follow up, 135 (14%) 46 bleeding; rates each did not differ between prescribing patterns. Post-index PDC >80% improved from 55% 80%.ConclusionsWhile most maintained after stroke/TIA, recurrent bleeding similar across Stroke/TIA severity may have influenced practices. adherence post-stroke/TIA signals an opportunity optimization AF.