Objective:

To investigate real-world usage of direct oral anticoagulants (DOACs) among atrial fibrillation (AF) patients presenting with cardioembolic stroke (CES) and evaluate the impact of prior DOAC therapy on stroke severity.

Approach:

Key Findings:

• 43.4% of CES patients with AF were not on anticoagulation therapy prior to the stroke, out of a total of 2,610 patients.
• Patients on DOACs had significantly milder strokes (mean NIHSS score: 8.84 vs. 11.58, p < 0.001).
• Stroke patients on DOACs exhibited larger left atrial volume indices (LAVI) compared to non-users (56.05 vs. 46.94, p < 0.001).

Interpretation:

Non-adherence to DOACs significantly contributes to the CES burden, and prior DOAC use correlates with reduced initial stroke severity, highlighting the need for improved adherence strategies.

Limitations:

• The study is retrospective and may be subject to selection bias.
• Data is limited to two hospitals in Latvia, which may not represent broader populations.
• Potential confounding factors may affect the results.

Conclusion:

Prior DOAC use is associated with reduced stroke severity in AF patients experiencing CES, underscoring the critical importance of adherence to anticoagulation therapy.

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