WSC 2026 | AF-BREACH criteria: standardizing the etiologic classification of breakthrough strokes
Ronda Lun, MD, MSc, FRCPC, University of Calgary, Calgary, Canada, discusses the development of the AF-BREACH criteria to standardize the etiologic classification of breakthrough strokes. Dr Lun explains that the criteria categorize patients into three groups: non-adherence, presence of another stroke cause, and meeting AF-BREACH criteria with appropriate medication and no other stroke causes. This interview took place at the 18th World Stroke Congress (WSC) in Seoul, Korea.
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Transcript
Yeah, so I think when we started to really look into the breakthrough stroke literature, we noticed that there was not a lot of guidance for the general practitioner in terms of what sort of investigations to consider. And so that’s exactly the aim of the AF-BREACH criteria is to try to standardize the etiologic classification of breakthrough strokes through a set of guided investigations, and also to try and select a patient population that is more homogeneous, potentially for future clinical trials...
Yeah, so I think when we started to really look into the breakthrough stroke literature, we noticed that there was not a lot of guidance for the general practitioner in terms of what sort of investigations to consider. And so that’s exactly the aim of the AF-BREACH criteria is to try to standardize the etiologic classification of breakthrough strokes through a set of guided investigations, and also to try and select a patient population that is more homogeneous, potentially for future clinical trials. The concept is similar to the ESUS construct, so the embolic stroke of undetermined source group of patients, where they were randomized to DOACs or antiplatelet therapies in various trials a few years ago. So that’s what it was structured after. The AF-BREACH criteria specifically tries to put patients into three big buckets. Patients who had non-failure, so for example, if they missed doses or if they had intentional interruptions, if their DOAC wasn’t appropriately chosen or appropriately dosed. And then patients who had another reason to have strokes, for example, you know, did they have large artery atherosclerosis? Did they have other reasons to be hypercoagulable? That’s the second bucket. And then that final bucket is patients that we call meeting AF-BREACH criteria, meaning that they had appropriate drugs, they were taking them, the right indications, without any other reasons that were found.
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