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.
Observational (n=326)
No
What is the incidence and what are the causes of breakthrough strokes in patients admitted with acute ischaemic stroke?
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.
Abstract Background and aims Breakthrough strokes can occur in patients taking antiplatelets or anticoagulation and occur at 1-2% per year but have a much higher recurrence rate at 9% per year. There are a several causes including poor adherence to treatment, uncontrolled risk factors and undiagnosed atrial fibrillation. We aimed to determine the incidence of breakthrough strokes in patients and look for possible causes. Methods We performed retrospective data collection of 326 patients admitted to a tertiary NHS hospital with acute ischaemic stroke confirmed on CT/MRI. Medication status, risk factors, previous stroke status and investigations results were recorded. Results Breakthrough stroke happened in 156 of patients (47.85%). 49 patients (15%) were taking clopidogrel, 39 (12%) on aspirin, 10 (3%) on dual antiplatelets and 59 (15.6%) anticoagulation. Atrial fibrillation was found in 10% of patients on clopidogrel and 20% of patients on aspirin. 85% of patients taking clopidogrel had previous stroke, compared to 42% on aspirin. Hypertension was the most common risk factors in all groups ranging from 67.5% in aspirin group to 81.6% in clopidogrel group. Mean HBA1c and cholesterol were within normal limits. Conclusions Incidence of breakthrough strokes was higher than expected despite adequate secondary preventive methods. In addition to checking compliance with treatment, addressing uncontrolled risk factors such as blood pressure control and screening for atrial fibrillation should be consider Conflict of interest Mohamed Maged: nothing to disclose, Louisa Rowland: nothing to disclose, Richard Marigold: nothing to disclose, Charis Mavrokordatos: nothing to disclose, Ehsan Ul Haq: nothing to disclose, Shady Elsalhawy: nothing to disclose, Bouchra Lahmar: nothing to disclose
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.