Continuation vs Switching Direct Oral Anticoagulant Therapy After Breakthrough Stroke

Among patients with atrial fibrillation experiencing a breakthrough ischemic stroke while receiving direct oral anticoagulant (DOAC) therapy, is switching to another oral anticoagulant associated with 90-day outcomes that are not meaningfully worse than continuing treatment with the same DOAC?In this cohort study including 1006 patients, 463 continued the same DOAC therapy and 543 switched to a different DOAC. Switching to a different DOAC was noninferior to continuing the same DOAC therapy in terms of a 90-day net clinical benefit.These findings suggest that switching DOACs after a breakthrough stroke may not be associated with clinically meaningful benefits in short-term outcomes.

Corresponding Authors: Lucio D’Anna, MD, PhD, Imperial College London, Charing Cross Campus, Fulham Palace Road, London W69RH, United Kingdom (l.danna@imperial.ac.uk); Simona Sacco, MD, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio snc, 67100, L’Aquila, Italy (simona.sacco@univaq.it).

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