Deniz KAMACI ŞENER, Cemile HAKİ, Tuba KALKAN, Suat KAMIŞLI
Journal of Medicine and Palliative Care - 2026;7(3):491-497
Aims: Ischemic stroke may still occur despite the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation. Data regarding the clinical characteristics and outcomes of these patients remain limited. This study aimed to evaluate the clinical characteristics of patients presenting with acute ischemic stroke despite ongoing NOAC therapy and to identify predictors of poor functional outcome. Methods: This retrospective single-center study included 139 patients receiving NOAC therapy who presented with acute ischemic stroke. Demographic, clinical, and treatment-related data were analyzed. Functional outcome at 3 months was assessed using the modified Rankin Scale (mRS), and factors associated with poor outcome were evaluated using multivariate logistic regression analysis. Results: The mean age was 75.5+/-9.9 years, and 57.6% of patients were female. Most patients (74.8%) were managed with medical treatment alone, while mechanical thrombectomy was performed in 23.0% of patients. Intravenous thrombolysis was rarely used (0.7%). Favorable functional outcome (mRS 0-2) at 3 months was observed in 56.1% of patients. Mechanical thrombectomy was identified as an independent predictor of favorable functional outcome (OR: 0.064, 95% CI: 0.009-0.446, p=0.006). In contrast, higher baseline NIHSS score and CHA?DS?-VASc score were independently associated with poor outcome. No significant differences were observed in clinical outcomes according to NOACs type, medication adherence, or dosing appropriateness. Conclusion: Ischemic stroke may still occur in patients receiving NOAC therapy, and its management remains challenging. Mechanical thrombectomy appears to be a key determinant of functional outcome and should be considered in appropriately selected patients. Improving medication adherence and appropriate dosing may also play an important role in patient management.
