Real-world use and impact of direct oral anticoagulants among atrial fibrillation patients with cardioembolic stroke
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By
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Vladislavs Sokaļskis
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Kaspars Kupics
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Kristaps Jurjāns
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Nikolajs Ņesterovičs
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Ieva Ozoliņa
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Guntis Karelis
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Evija Miglāne
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Andrejs Ērglis
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June 18, 2026
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Clinical Scorecard: Utilization and Effects of Direct Oral Anticoagulants in Atrial Fibrillation Patients Experiencing Cardioembolic Stroke
At a Glance
| Category | Detail |
|---|
| Condition | Atrial Fibrillation and Cardioembolic Stroke |
| Key Mechanisms | Direct Oral Anticoagulants reduce thromboembolic events and improve safety profile compared to vitamin K antagonists. |
| Target Population | Patients with Atrial Fibrillation presenting with Cardioembolic Stroke. |
| Care Setting | Neurovascular Departments of university hospitals. |
Key Highlights
- 43.4% of CES patients with AF were not on anticoagulation therapy before the stroke.
- Patients on DOACs had significantly milder strokes compared to non-users (mean NIHSS score: 8.84 vs. 11.58).
- Stroke patients on DOAC therapy exhibited larger left atrial volume indices (LAVI).
- 55.8% of Latvian AF patients were not taking DOACs regularly.
- Adequate adherence to DOACs is associated with a 31% reduction in ischemic stroke.
Guideline-Based Recommendations
Diagnosis
- Diagnosis based on TOAST criteria using CT data.
Management
- Encourage adherence to DOAC therapy to reduce stroke severity.
Monitoring & Follow-up
- Monitor adherence to DOACs to improve clinical outcomes.
Risks
- Non-adherence to DOACs significantly contributes to the burden of cardioembolic strokes.
Patient & Prescribing Data
Atrial Fibrillation patients experiencing Cardioembolic Stroke.
Prior DOAC use is associated with reduced initial stroke severity.
Clinical Best Practices
- Utilize national health registry data to assess DOAC adherence.
- Implement strategies to improve patient adherence to anticoagulation therapy.
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