ISC 2024 | Assessing risk in patients with breakthrough stroke in atrial fibrillation

Valeria Caso, MD, PhD, FESO, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy, discusses key factors when assessing risk in patients with atrial fibrillation (AF) who experience ischemic stroke despite oral anticoagulation. Breakthrough strokes are not uncommon and identify an important patient subgroup at high risk of stroke recurrence and mortality. Prof. Caso notes the importance of shedding light on the mechanism underlying anticoagulation failure in order to implement preventive measures. For example, insufficient OAC is seen in almost one-third of AF patients with stroke despite OAC. Additionally, around 30% of strokes due to OAC failure may be attributed to competing non-cardioembolic mechanisms. The third category, cardioembolic stroke despite adequate OAC, represents a more challenging clinical scenario. Prof. Caso discusses the need for a detailed global risk assessment of the patient to identify areas for intervention. This interview took place during the International Stroke Conference 2024 in Phoenix, AZ.

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