Identification of Optimal Anticoagulant Strategies Following Ischemic Stroke While on DOACs

Background: Ischemic stroke in patients with atrial fibrillation (AF) taking oral anticoagulants can be challenging, as breakthrough strokes can still occur. There are no clear guidelines on the best approach to changing anticoagulant classes. Objective: To identify optimal anticoagulant strategies following ischemic stroke while on direct oral anticoagulants (DOACs). Design: Systematic review and meta-analysis. Methods: A comprehensive search was conducted on MEDLINE, Scopus, and the Cochrane Library. Selected studies enrolled adult patients who experienced a stroke while on DOACs, assessed interventions involving changes in anticoagulant therapy (dosage adjustment, switching to a vitamin K antagonist or other DOAC), and reported on ≥1 of the primary or secondary outcomes. Randomized controlled clinical trials (RCTs), cohort, and observational studies comparing ≥2 anticoagulant strategies were included. Exclusion criteria included sample size of Results: 2171 results, with 8 o more...