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Volume 14
Issue 17
10.3390/jcm14176012
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Ischaemic Stroke in Patients with Known Atrial Fibrillation: A Snapshot from a Large University Hospital Experience

by
Giulia Domna Scrima
1,†,
Cristina Sarti
1,2,*,†,
Giovanni Pracucci
1,
Rita Nistri
3,
Costanza Maria Rapillo
4,
Benedetta Piccardi
2,
Miroslava Stolcova
5,
Francesca Ristalli
5,
Alessio Mattesini
5,
Carlo Nozzoli
6,
Alessandro Morettini
7,
Alberto Moggi Pignone
8,
Patrizia Nencini
2,
Carlo Di Mario
5,
Rossella Marcucci
9 and
Francesco Meucci
5 on behalf of Heart and Brain Team, Careggi University Hospital
1
Department of Neurofarba, University of Florence, 50134 Florence, Italy
2
Stroke Unit, Careggi University Hospital (AOUC), 50139 Florence, Italy
3
Department of Heart and Vessels, Careggi University Hospital (AOUC), 50134 Florence, Italy
4
Neurology and Stroke Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, 20089 Rozzano, Italy
5
Structural Interventional Cardiology, Careggi University Hospital (AOUC), 50134 Florence, Italy
6
Internal Medicine 1, Careggi University Hospital (AOUC), 50134 Florence, Italy
7
Internal Medicine 2, Careggi University Hospital (AOUC), 50134 Florence, Italy
8
Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
9
Atherothrombotic Diseases, Careggi University Hospital (AOUC), 50134 Florence, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2025, 14(17), 6012; https://doi.org/10.3390/jcm14176012 (registering DOI)
Submission received: 18 July 2025 / Revised: 14 August 2025 / Accepted: 18 August 2025 / Published: 25 August 2025
(This article belongs to the Special Issue Application of Anticoagulation and Antiplatelet Therapy)
Versions Notes

Abstract

Objectives: Atrial fibrillation (AF) is associated with high risk of ischaemic stroke (IS). Oral anticoagulant therapy (OAT) is the standard of care for stroke prevention, even though its management remains challenging in clinical practice. An emerging problem is embolic events occurring on adequately conducted OAT, the so-called resistant stroke (RS). We aimed to describe pre-stroke prevention therapy, management on hospital discharge, and therapy at follow-up in all patients with AF hospitalized for IS and in the RS subgroup. Methods: We conducted a retrospective monocentric study of patients with known AF hospitalized for an IS. A subgroup with RS was identified. We recorded information on prevention therapy at home, recommended therapy at discharge, and data on outcome and prevention therapy at follow-up. Results: We identified 226 patients, 61% females, median age 84.04 years. Preventive therapy at home was performed in 121 (53.5%) (119 OAT and 2 Left Atrial Appendage Occlusion). At hospital discharge OAT was prescribed to 78.2% of patients. RS was diagnosed in 33 patients whose management at discharge was: same OAT in 12, shift to another Direct Oral Anticoauglant (DOAC) in 5, from DOAC to Vitamin K Antagonist (VKA) and vice versa in 11, non-specified OAT in 4. At final, follow-up of 208 days (range 85–443) 23.3% (34/146) did not assume OAT. OAT was significantly associated with survival probability (p < 0.001). Conclusions: Our findings confirm a scarce adoption of guidelines for AF-related embolic events, even in the absence of absolute contraindication to OAT. RS remains an underexplored clinical entity with empirical management, highlighting the need for targeted research and tailored therapeutic strategies.
Keywords: atrial fibrillation; oral anticoagulant therapy; resistant stroke atrial fibrillation; oral anticoagulant therapy; resistant stroke

Share and Cite

MDPI and ACS Style

Scrima, G.D.; Sarti, C.; Pracucci, G.; Nistri, R.; Rapillo, C.M.; Piccardi, B.; Stolcova, M.; Ristalli, F.; Mattesini, A.; Nozzoli, C.; et al. Ischaemic Stroke in Patients with Known Atrial Fibrillation: A Snapshot from a Large University Hospital Experience. J. Clin. Med. 2025, 14, 6012. https://doi.org/10.3390/jcm14176012

AMA Style

Scrima GD, Sarti C, Pracucci G, Nistri R, Rapillo CM, Piccardi B, Stolcova M, Ristalli F, Mattesini A, Nozzoli C, et al. Ischaemic Stroke in Patients with Known Atrial Fibrillation: A Snapshot from a Large University Hospital Experience. Journal of Clinical Medicine. 2025; 14(17):6012. https://doi.org/10.3390/jcm14176012

Chicago/Turabian Style

Scrima, Giulia Domna, Cristina Sarti, Giovanni Pracucci, Rita Nistri, Costanza Maria Rapillo, Benedetta Piccardi, Miroslava Stolcova, Francesca Ristalli, Alessio Mattesini, Carlo Nozzoli, and et al. 2025. "Ischaemic Stroke in Patients with Known Atrial Fibrillation: A Snapshot from a Large University Hospital Experience" Journal of Clinical Medicine 14, no. 17: 6012. https://doi.org/10.3390/jcm14176012

APA Style

Scrima, G. D., Sarti, C., Pracucci, G., Nistri, R., Rapillo, C. M., Piccardi, B., Stolcova, M., Ristalli, F., Mattesini, A., Nozzoli, C., Morettini, A., Moggi Pignone, A., Nencini, P., Di Mario, C., Marcucci, R., & Meucci, F., on behalf of Heart and Brain Team, Careggi University Hospital. (2025). Ischaemic Stroke in Patients with Known Atrial Fibrillation: A Snapshot from a Large University Hospital Experience. Journal of Clinical Medicine, 14(17), 6012. https://doi.org/10.3390/jcm14176012

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