Evidence map›Paper›PMID 41696675›Full record

ArticleTherapeutic advances in neurological disorders2026

Acute ischemic stroke or TIA despite DOAC treatment: the contribution of DOAC plasma levels to understand pathophysiological mechanisms.

Marcus Rust, Merve Gözalan, Omid Nikoubashman, Martin Wiesmann, Matthias Imöhl, Jörg B Schulz, Arno Reich, João Pinho

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In one paragraph

Article in Therapeutic advances in neurological disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Marcus RustDepartment of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany.
Merve GözalanDepartment of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany.
Omid NikoubashmanDepartment of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany.
Martin WiesmannDepartment of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany.
Matthias ImöhlLaboratory Diagnostic Center, University Hospital, RWTH Aachen University, Aachen, Germany.
Jörg B SchulzDepartment of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany.ORCID https://orcid.org/0000-0002-8903-0593
Arno ReichDepartment of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany.ORCID https://orcid.org/0000-0002-9439-7963
João PinhoDepartment of Neurology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, Aachen 52074, Germany.ORCID https://orcid.org/0000-0002-3977-7146

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Ischemic stroke or transient ischemic attack (TIA) occurs in 1.4% of patients with atrial fibrillation (AF) per year despite treatment with direct oral anticoagulants (DOACs). This group of patients is poorly studied, and possible causes for this are not fully understood. Objectives: The aim of the study was to analyze DOAC plasma levels in patients who had ischemic stroke or TIA despite treatment with DOAC. Design: Monocentric retrospective study. Methods: We selected consecutive DOAC-treated patients with acute ischemic stroke or TIA, admitted during a 2-year period, with measurement of DOAC levels ⩽24 h after hospital admission. Patients with and without low DOAC levels (<50 ng/mL) were compared. Results: We included 163 patients with median age of 80 years, 46.6% of female sex. AF was the most frequent indication for DOAC (83.4%). Low DOAC levels were found in 42.3% of patients. Patients with low DOAC levels more frequently were being treated with an inappropriate low DOAC dose (29.4% vs 16.0%, Conclusion: In DOAC-treated patients with ischemic stroke or TIA, low DOAC levels were found in 2/5 of patients. Lower DOAC levels are associated with increased stroke severity and the presence of LVO/MeVO. The profile of stroke etiology in DOAC-treated patients varies between groups with and without low DOAC levels.

Indexed as

anticoagulantsatrial fibrillationdirect-acting oral anticoagulantstroke

Identifiers

PMID41696675
PMCPMC12901951

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