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Isa Oboirien: Stroke Despite Anticoagulation – What Is the Cause

Isa Oboirien/LinkedIn, Umberto Pensato/LinkedIn

Aug 17, 2026, 14:50

Isa Oboirien: Stroke Despite Anticoagulation – What Is the Cause

Isa Oboirien, Higher Specialty Trainee at Health Education England, shared Umberto Pensato‘s post on LinkedIn, adding:

“This is a timely and highly relevant review addressing an important gap in contemporary stroke practice.

Breakthrough ischaemic stroke in patients with atrial fibrillation despite therapeutic anticoagulation remains a challenging clinical scenario, particularly when trying to establish the underlying mechanism and determine the optimal strategy for secondary prevention.

A structured approach to investigating whether these events reflect competing stroke mechanisms, inadequate anticoagulant exposure, or true anticoagulation failure is therefore invaluable.

This review provides much-needed clarity in an area where evidence to guide everyday clinical decision-making remains limited.

Congratulations Umberto Pensato and colleagues.”

Umberto Pensato, Assistant Professor of Neurology at the Humanitas University, Research Collaborator at the University of Calgary, shared a post on LinkedIn about a recent article he and his colleagues co-authored, published in BMJ, adding:

“Out now on the BMJ, our comprehensive review on breakthrough stroke (stroke despite DOAC) which accounts for nearly one in seven ischemic stroke in daily practice (yet has been largely neglected until recently).

Here we review the epidemiology, mechanisms, a framework for classification, and mangement of this condition.

Notably, we also propose a systematic, stepwise algorithm for investigation, along with standardized criteria to select patients for future randomized clinical trials (AF-BREACH criteria).

Congratulations to Ronda Lun for leading this review over the last two years and pulling together a terrific international, multidisciplinary team covering neurology, cardiology, and hematology.”

Title: Investigation and management of breakthrough ischemic stroke in anticoagulated patients with atrial fibrillation

Authors: Caroline M. Schaap, Jimmy Schenk, Susanne Eberl, Marcella C.A. Müller, Alexander P.J. Vlaar, Marcel A.M. Beijk, Maurice A.P. Oudeman, Maaike M. Roefs, Maarten ter Horst, Henning Hermanns

Isa Oboirien: Stroke Despite Anticoagulation - What Is the Cause