{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:29:26Z","timestamp":1790116166666,"version":"4.0.1"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,2,6]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The optimal antithrombotic strategies for patients with atrial fibrillation who experience ischemic stroke (IS) despite direct oral anticoagulant (DOAC) therapy remain inconclusive. This study compared outcomes for patients with DOAC treatment failure who changed or retained their prestroke DOAC.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">This retrospective cohort study analyzed data from the National Health Insurance Research Database from 2012 to 2020. Patients with atrial fibrillation who experienced IS during DOAC therapy were assigned to either (1) the DOAC\u2010change group: changing prestroke DOAC or (2) the DOAC\u2010retain group: retaining prestroke DOAC. The primary outcome was a composite of recurrent IS and transient ischemic attack. The secondary outcomes included intracranial hemorrhage, major bleeding, systemic thromboembolism, and all\u2010cause death. Propensity score\u2013based inverse probability of treatment weighting was applied to balance the baseline characteristics between the DOAC\u2010change and DOAC\u2010retain groups. The Cox proportional hazards model compared the risk of outcomes between the 2 groups. In total, 1979 patients were enrolled (609 DOAC\u2010change patients and 1370 DOAC\u2010retain patients). The incidence rates of recurrent IS or transient ischemic attack were 7.20 and 6.56 per 100 person\u2010years in the DOAC\u2010change and DOAC\u2010retain groups, respectively (hazard ratio [HR], 1.07 [95% CI, 0.87\u20131.30]). A nonsignificantly higher incidence rate of intracranial hemorrhage was observed in the DOAC\u2010change group compared with the DOAC\u2010retain group (0.75 versus 0.53 per 100\u2010person\u2010years; HR, 1.49 [95% CI, 0.78\u20132.83]). The systemic thromboembolism, major bleeding, and death rates were comparable between the DOAC\u2010change and DOAC\u2010retain groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Changing prestroke DOAC does not reduce the risk of recurrent cerebral ischemia in patients with atrial fibrillation who develop IS during DOAC therapy. However, future studies should continue to observe the potential trends of increased intracranial hemorrhage risk.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.032454","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T11:18:42Z","timestamp":1706699922000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant Treatment"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7319-6644","authenticated-orcid":false,"given":"Shin\u2010Yi","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Pharmacy National Taiwan University Hospital Taipei Taiwan"},{"name":"School of Pharmacy, College of Medicine National Taiwan University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun\u2010Tsz","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Taiwan University Hospital Taipei Taiwan"},{"name":"Institute of Health Policy and Management College of Public Health, National Taiwan University Taipei Taiwan"},{"name":"Master of Public Health Program College of Public Health, National Taiwan University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3731-5973","authenticated-orcid":false,"given":"Sung\u2010Chun","family":"Tang","sequence":"additional","affiliation":[{"name":"Stroke Center and Department of Neurology National Taiwan University Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4882-2826","authenticated-orcid":false,"given":"Ching\u2010Ching Claire","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute of Health Policy and Management College of Public Health, National Taiwan University Taipei Taiwan"},{"name":"Master of Public Health Program College of Public Health, National Taiwan University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4597-4859","authenticated-orcid":false,"given":"Chi\u2010Chuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Taiwan University Hospital Taipei Taiwan"},{"name":"School of Pharmacy, College of Medicine National Taiwan University Taipei Taiwan"},{"name":"Graduate Institute of Clinical Pharmacy, College of Medicine National Taiwan University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000665"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.0000000000000375"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euab065"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2020.07.022"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.115.003074"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2927"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2020.02.003"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2021-328391"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(10)70274-x"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(12)70092-3"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(12)70042-x"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.116.013540"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25700"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2021-326166"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2015.01.009"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000207422"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.122.041197"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/suab152"}],"container-title":["Journal 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