{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T04:55:44Z","timestamp":1781758544985,"version":"3.54.5"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Atrial fibrillation (AF) is a primary cause of cardioembolic stroke (CES). Non-adherence to direct oral anticoagulants (DOACs) remains a major health policy issue. This study aimed to investigate real-world DOAC usage among AF patients presenting with stroke and to evaluate the impact of prior DOAC therapy on stroke severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study analyzed data on DOAC usage from CES patients with AF admitted to the two largest Latvian university hospitals between January 2022 and December 2024. We further compared patients\u2019 characteristics receiving prior DOAC therapy and those who were not, confirming our findings by a propensity-matched analysis of both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 2,610 CES patients enrolled, the largest subgroup (43.4%) consisted of individuals with known AF who were not on anticoagulation therapy before the stroke event. A propensity-matched analysis adjusted for demographics, arrival time, AF type, HAS-BLED, and CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VA score (352 patients per group) revealed that patients taking DOACs presented with significantly milder strokes than non-users (mean admission NIHSS score: 8.84\u202f\u00b1\u202f6.76 vs. 11.58\u202f\u00b1\u202f6.98,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Stroke patients on DOAC therapy demonstrated significantly larger left atrial volume indices (LAVI) than non-users (56.05\u202f\u00b1\u202f19.31 vs. 46.94\u202f\u00b1\u202f14.33, respectively;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Non-adherence to DOACs is a substantial contributor to the CES burden. Prior DOAC use is associated with significantly reduced initial stroke severity. Patients with CES while on DOACs exhibited substantially larger left atria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1844341","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T04:40:39Z","timestamp":1781757639000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world use and impact of direct oral anticoagulants among atrial fibrillation patients with cardioembolic stroke"],"prefix":"10.3389","volume":"17","author":[{"given":"Vladislavs","family":"Soka\u013cskis","sequence":"first","affiliation":[{"name":"Clinic of Cardiovascular Diseases, Riga East University Hospital","place":["Riga, Latvia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaspars","family":"Kupics","sequence":"additional","affiliation":[{"name":"Latvian Cardiology Center, Paul Stradins Clinical University Hospital","place":["Riga, Latvia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristaps","family":"Jurj\u0101ns","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Pauls Stradins Clinical University Hospital","place":["Riga, Latvia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolajs","family":"\u0145esterovi\u010ds","sequence":"additional","affiliation":[{"name":"Latvian Cardiology Center, Paul Stradins Clinical University Hospital","place":["Riga, Latvia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ieva","family":"Ozoli\u0146a","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Riga East University Hospital","place":["Riga, Latvia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guntis","family":"Karelis","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Riga East University Hospital","place":["Riga, Latvia"]},{"name":"Department of Infectology, Riga Stradins University","place":["Riga, Latvia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evija","family":"Migl\u0101ne","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Pauls Stradins Clinical University Hospital","place":["Riga, Latvia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrejs","family":"\u0112rglis","sequence":"additional","affiliation":[{"name":"Latvian Cardiology Center, Paul Stradins Clinical University Hospital","place":["Riga, Latvia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/S0140-6736(14)61774-8","article-title":"50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham heart study: a cohort 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A real-world study with atrial fibrillation patients treated with oral anticoagulants in Spain","volume":"9","author":"Hurtado-Navarro","year":"2018","journal-title":"Front Pharmacol"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaf250","article-title":"Adherence to oral thromboprophylaxis in atrial fibrillation: an overview for clinicians","volume":"27","author":"Potpara","year":"2025","journal-title":"Europace"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e037014","DOI":"10.1161\/JAHA.124.037014","article-title":"Prior anticoagulation and risk of Hemorrhagic transformation in acute stroke: A post hoc analysis of the PRODAST study","volume":"14","author":"Grosse","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1002\/ana.25917","article-title":"Prior anticoagulation in patients with ischemic stroke and atrial fibrillation","volume":"89","author":"Meinel","year":"2021","journal-title":"Ann Neurol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1001\/jama.2017.1371","article-title":"Association of preceding antithrombotic treatment with acute ischemic stroke severity and in-hospital outcomes among patients with atrial fibrillation","volume":"317","author":"Xian","year":"2017","journal-title":"JAMA"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2168","DOI":"10.1161\/STROKEAHA.119.025350","article-title":"Causes and risk factors of cerebral ischemic events in patients with atrial fibrillation treated with non\u2013vitamin K antagonist Oral anticoagulants for stroke prevention","volume":"50","author":"Paciaroni","year":"2019","journal-title":"Stroke"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1136\/jnnp-2021-326166","article-title":"Ischaemic stroke on anticoagulation therapy and early recurrence in acute cardioembolic stroke: the IAC study","volume":"92","author":"Yaghi","year":"2021","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e006402","DOI":"10.1161\/JAHA.117.006402","article-title":"Left atrial size and long-term risk of recurrent stroke after acute ischemic stroke in patients with nonvalvular atrial fibrillation","volume":"6","author":"Ogata","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"ref26","year":""},{"key":"ref27","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","article-title":"Classification of subtypes of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. 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