Abstract Number: Esoc2026a1556 Occurrence of Cardioembolic Ischemic Stroke in Atrial Fibrillation Patients on Doac Therapy: A Single Center Real-World Data

Abstract Background and aims Direct oral anticoagulants (DOACs) are used for the prevention of cardioembolic ischemic stroke (CES) in patients with atrial fibrillation (AF). Their effectiveness is supported by randomized non-inferiority trials comparing DOACs with vitamin K antagonists. Despite the exposure to DOAC, in clinical practice it is not uncommon to observe patients who experience a first episode or recurrence of CES. The aim of the study is to determine how many patients with AF exposed to DOACs develop CES. Methods We perfomed a retrospective observational study at IRCCS Fondazione Policlinico Gemelli (June 2024–December 2025). Patients with a prior diagnosis of AF receiving DOAC therapy (rivaroxaban, apixaban, edoxaban, dabigatran) presenting with ischemic stroke were included. Results During the observation period 376 patients with ischemic stroke were admitted to the Stroke Unit of Policlinico Gemelli. 64 patients were discharged with a diagnosis of CES due to AF. Among these, a few were diagnosed with AF during hospitalisation, while 44 patients (69 %) were treated with DOACs for AF before the index event. Conclusions Despite DOAC therapy ischemic stroke may occur in AF patients. To reduce the incidence of CES, it is necessary to investigate the pharmacological efficacy through targeted studies that take into account therapeutic adherence, drug plasma levels, comorbidities and drug interactions. Conflict of interest Name of author: nothing to disclose