July 27, 2026 · BMJ (Clinical research ed.) · DOI: 10.1136/bmj-2025-084905

Investigation and management of breakthrough ischemic stroke in anticoagulated patients with atrial fibrillation

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This review investigates the phenomenon of breakthrough ischemic strokes in patients with atrial fibrillation who are on direct oral anticoagulants, despite appropriate treatment. The authors aim to understand the epidemiology and mechanisms behind these strokes, propose a systematic approach for their investigation, and discuss potential management strategies. They also introduce the AF-BREACH criteria to help identify suitable candidates for future clinical trials.

Ronda Lun, Umberto Pensato, Joseph R Shaw, Carlo A Pivato, Luciano A Sposato, Thalia S Field, Andrew M Demchuk

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