Thromboembolism Despite Anticoagulation in Atrial Fibrillation

Oral anticoagulation therapy significantly reduces the risk of thromboembolism in patients with atrial fibrillation (AF).

Despite anticoagulation therapy, 30 % of patients with AF experience an ischaemic stroke. The main causes include:

For secondary prevention of recurrent stroke, the following may be considered:

adding antiplatelet therapy to anticoagulation therapy, which increases bleeding risk
switching anticoagulation therapy to an agent with a different mechanism of action:

Thromboembolism and Atrial Fibrillation During Anticoagulation Therapy	Class
In a patient with atrial fibrillation (AF) receiving anticoagulation therapy who develops a stroke, comprehensive evaluation is recommended.	I
In a patient with AF receiving anticoagulation therapy who develops a stroke, switching anticoagulation therapy may be considered.	IIb
In a patient with AF receiving anticoagulation therapy who develops a stroke, adding antiplatelet therapy to anticoagulation may be considered.	IIb