Acute ischemic stroke despite NOAC therapy in atrial fibrillation: Clinical factors associated with AIS in a 2-center observational case-control study.
- 1Department of Neurology, Health Sciences University, Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey.
- 2Department of Cardiology, Health Sciences University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Abstract
Acute ischemic stroke (AIS) can occur in patients with non-valvular atrial fibrillation (AF) despite treatment with non-vitamin K antagonist oral anticoagulants (NOACs). This study evaluated clinical, treatment-related, inflammatory, and echocardiographic factors associated with AIS in NOAC-treated patients with AF. This retrospective, 2-center case-control study included 322 patients with non-valvular AF who had received NOAC therapy for at least 3 months. Of these, 112 were hospitalized with AIS and 210 were outpatient controls without AIS at the study assessment. Group differences and factors associated with AIS were evaluated using multivariable logistic regression. ROC analyses were exploratory. Patients with AIS were older than controls and more often had hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, prior stroke, and prescribed reduced-dose NOAC use. In the adjusted analysis, prior stroke (OR = 32.79), coronary artery disease (OR = 3.47), prescribed reduced-dose NOAC use (OR = 2.55), female sex (OR = 2.26), diabetes mellitus (OR = 1.99), and C-reactive protein (OR per mg/L = 1.10) were associated with AIS. HAS-BLED (area under the curve = 0.881, 95% CI = 0.844-0.918) and CHA2DS2-VASc (area under the curve = 0.840, 95% CI = 0.795-0.885) distinguished AIS cases from controls in exploratory ROC analyses. Among NOAC-treated patients with AF, prior stroke and cardiovascular comorbidities were strongly associated with AIS. Prescribed reduced-dose NOAC use was also associated with AIS. Inflammatory markers measured during acute stroke had limited additional value. Because this was a case-control study, the findings do not estimate stroke incidence or future stroke risk and require prospective validation.
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BibTeX
@article{gul2026acute,
title = {{Acute ischemic stroke despite NOAC therapy in atrial fibrillation: Clinical factors associated with AIS in a 2-center observational case-control study.}},
author = {Zeynep Bastug Gul and Nasrullah Danisman and Ebru Ozbezen Kiziltan and Gulhan Yildirim Ozdemir and Vasfiye Kabeloglu and Serkan Yazan and Mehmet Gul},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051189},
url = {https://europepmc.org/article/MED/42888612},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Acute ischemic stroke despite NOAC therapy in atrial fibrillation: Clinical factors associated with AIS in a 2-center observational case-control study.
AU - Zeynep Bastug Gul
AU - Nasrullah Danisman
AU - Ebru Ozbezen Kiziltan
AU - Gulhan Yildirim Ozdemir
AU - Vasfiye Kabeloglu
AU - Serkan Yazan
AU - Mehmet Gul
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000051189
UR - https://europepmc.org/article/MED/42888612
AB - Acute ischemic stroke (AIS) can occur in patients with non-valvular atrial fibrillation (AF) despite treatment with non-vitamin K antagonist oral anticoagulants (NOACs). This study evaluated clinical, treatment-related, inflammatory, and echocardiographic factors associated with AIS in NOAC-treated patients with AF. This retrospective, 2-center case-control study included 322 patients with non-valvular AF who had received NOAC therapy for at least 3 months. Of these, 112 were hospitalized with AIS and 210 were outpatient controls without AIS at the study assessment. Group differences and factors associated with AIS were evaluated using multivariable logistic regression. ROC analyses were exploratory. Patients with AIS were older than controls and more often had hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, prior stroke, and prescribed reduced-dose NOAC use. In the adjusted analysis, prior stroke (OR = 32.79), coronary artery disease (OR = 3.47), prescribed reduced-dose NOAC use (OR = 2.55), female sex (OR = 2.26), diabetes mellitus (OR = 1.99), and C-reactive protein (OR per mg/L = 1.10) were associated with AIS. HAS-BLED (area under the curve = 0.881, 95% CI = 0.844-0.918) and CHA2DS2-VASc (area under the curve = 0.840, 95% CI = 0.795-0.885) distinguished AIS cases from controls in exploratory ROC analyses. Among NOAC-treated patients with AF, prior stroke and cardiovascular comorbidities were strongly associated with AIS. Prescribed reduced-dose NOAC use was also associated with AIS. Inflammatory markers measured during acute stroke had limited additional value. Because this was a case-control study, the findings do not estimate stroke incidence or future stroke risk and require prospective validation.
SN - 0304-5412
SN - 1536-5964
ER -