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May 8, 2026European Stroke Journal

Prior antithrombotics linked to ~48% breakthrough stroke incidence in acute admissions, with hypertension the top risk.

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Why the study?

Breakthrough strokes occur in patients taking antiplatelets or anticoagulation, with high recurrence rates and multiple potential causes; this audit aimed to determine their incidence and investigate possible causes.

What is the incidence and what are the causes of breakthrough strokes in patients admitted with acute ischaemic stroke?

Population

326 patients admitted to a tertiary NHS hospital with acute ischaemic stroke confirmed on CT/MRI

Design

Retrospective audit

Key result

Breakthrough strokes occurred in 47.85% of patients admitted with acute ischaemic stroke, with hypertension being the most common risk factor across all medication groups.

Authors

MMMohamed MagedLRLouisa RowlandRMRichard Marigold

Discussion

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Overview

Urges caution with single antiplatelet therapy for secondary stroke prevention; leaves open superior strategies pending RCTs.

Key Points

  • To determine the incidence of breakthrough strokes and identify their potential causes in patients treated with antiplatelets or anticoagulation.
  • Retrospective data collection from 326 patients admitted with acute ischaemic stroke confirmed by CT/MRI.
  • Data on medication status, risk factors, previous stroke, and investigation results were recorded.
  • Breakthrough stroke incidence was 47.85% in the assessed population.
  • 15% of patients on clopidogrel had a breakthrough stroke compared to 12% on aspirin, and 3% on dual antiplatelets.
  • Hypertension was the most prevalent risk factor, affecting 67.5% to 81.6% of patients, depending on medication group.

Study Design

Type

Observational (n=326)

Multicenter

No

Structured PICO

What is the incidence and what are the causes of breakthrough strokes in patients admitted with acute ischaemic stroke?

P
Population
326 patients admitted to a tertiary NHS hospital with acute ischaemic stroke confirmed on CT/MRI
I
Intervention
Antiplatelet or anticoagulation therapy prior to admission
O
Outcome
Incidence of breakthrough strokes and possible causeshard clinical

Breakthrough strokes occurred in nearly half of patients admitted with acute ischemic stroke, highlighting the need to address uncontrolled risk factors like hypertension and screen for atrial fibrillation.

Cite This Study

Maged et al. (2026) conducted an observational in Acute ischaemic stroke (n=326). Antiplatelets or anticoagulation was evaluated on Incidence of breakthrough strokes. Breakthrough strokes occurred in 47.85% of patients admitted with acute ischaemic stroke, with hypertension being the most common risk factor across all medication groups.

synapsesocial.com/papers/69fd7e00bfa21ec5bbf06270https://doi.org/10.1093/esj/aakag023.1375
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