How do you manage patients with atrial fibrillation having a thromboembolic infarct despite being on adequate anticoagulation?

This scenario is always challenging. In terms of anticoagulation, the efficacy of DOACs in preventing embolic events in AF patients is around 70%, which is impressive compared to warfarin but not foolproof. In cases of a second embolic event while on anticoagulation, two reasonable approaches are of...

In addition to what Dr. @Dr. First Last and Dr. @Dr. First Last said, I would like to add that evaluating for underlying hyper-coagulable states like occult or active malignancy or anti-phospholipid antibody syndrome. There have been reports of higher DOAC failure rates in those with aggressive form...

If the DOAC is not apixaban, I would switch to that drug, since it has shown superior efficacy in some studies. If it is apixaban, I would consider switching to warfarin after making sure that the stroke workup has been completed, including hypercoagulable states, cardiac abnormalities, etc.

Previou...

Updating some of the available evidence regarding ischemic stroke while on DOAC for atrial fibrillation, since much of the discussion was in 2024:

This topic of "breakthrough stroke" has been investigated ever since the 2020 paper by David Seiffge using multi-center pooled observational registry data...