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She presented with neurological deficits consistent with a left middle cerebral artery stroke, confirmed via head imaging; the most likely stroke aetiology was determined to be cardioembolic in the setting of NVAF. She was treated with <jats:italic>continuation<\/jats:italic> of her apixaban at the <jats:italic>same dosage<\/jats:italic>. She displayed improved function, although with residual expressive aphasia at her 2-month neurology follow-up. Cardioembolic ischaemic stroke in NVAF despite current NOAC therapy does not have current management guidelines.<\/jats:p>","DOI":"10.1136\/bcr-2023-258761","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T13:16:18Z","timestamp":1704892578000},"page":"e258761","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Ischaemic stroke in a patient with non-valvular atrial fibrillation (NVAF) despite non-vitamin K oral anticoagulant (NOAC) therapy"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9142-7242","authenticated-orcid":false,"given":"Simon","family":"Zhen","sequence":"first","affiliation":[{"name":"Medicine, Albert Einstein College of Medicine, Bronx, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fion","family":"Chu","sequence":"additional","affiliation":[{"name":"Medicine, Albert Einstein College of Medicine, Bronx, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afek","family":"Kodesh","sequence":"additional","affiliation":[{"name":"Internal Medicine, Montefiore Medical Center, Bronx, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jisoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Internal Medicine, Montefiore Medical Center, Bronx, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,1,10]]},"reference":[{"key":"2025082711024911000_17.1.e258761.1","doi-asserted-by":"crossref","first-page":"199","DOI":"10.5853\/jos.2022.03552","article-title":"Occurrence of ischemic stroke in patients with atrial fibrillation receiving non-vitamin K oral anticoagulants: causes and prevention strategies","volume":"25","author":"Bang","year":"2023","journal-title":"J Stroke"},{"key":"2025082711024911000_17.1.e258761.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.049768"},{"key":"2025082711024911000_17.1.e258761.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905561"},{"key":"2025082711024911000_17.1.e258761.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009638"},{"key":"2025082711024911000_17.1.e258761.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107039"},{"key":"2025082711024911000_17.1.e258761.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310907"},{"key":"2025082711024911000_17.1.e258761.7","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.027275"},{"key":"2025082711024911000_17.1.e258761.8","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2021-326166"},{"key":"2025082711024911000_17.1.e258761.9","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25700"},{"key":"2025082711024911000_17.1.e258761.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2019.01.024"},{"key":"2025082711024911000_17.1.e258761.11","doi-asserted-by":"crossref","DOI":"10.1093\/eurheartj\/ehaa798","article-title":"ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic surgery (EACTS)","volume":"42","year":"2021","journal-title":"Eur Heart J"},{"key":"2025082711024911000_17.1.e258761.12","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1093\/europace\/euab303","article-title":"Worldwide trends in oral anticoagulant use in patients with atrial fibrillation from 2010 to 2018: a systematic review and meta-analysis","volume":"24","author":"Grymonprez","year":"2022","journal-title":"EP Europace"},{"key":"2025082711024911000_17.1.e258761.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2008.07.003"},{"key":"2025082711024911000_17.1.e258761.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-5949.2011.00292.x"},{"key":"2025082711024911000_17.1.e258761.15","unstructured":"Hughes RE , Tadi P , Bollu PC . 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