JAMA Neurol

How common is stroke recurrence in afib patients despite anticoagulation?

June 17, 2025

Study details: This systematic review and meta-analysis assessed the residual risk of recurrent stroke in patients with afib who were treated with oral anticoagulants (OACs). Researchers searched MEDLINE and Embase through January 2025 for studies enrolling patients with prior ischemic stroke and afib, with at least one year of follow-up. Twenty-three studies met inclusion criteria, encompassing 78,733 patients and over 140,000 person-years of follow-up.

Results: The pooled annual incidence of recurrent ischemic stroke was 3.75% (95% confidence interval [CI], 3.17%–4.33%), with higher rates in observational studies (4.20%) than in randomized trials (2.26%). The risk of any recurrent stroke was 4.88% per year, and intracerebral hemorrhage (ICH) occurred at 0.58% annually. Among patients who had a stroke despite OAC, risks rose to 7.20% for ischemic stroke, 8.96% for any stroke, and 1.40% for ICH.

Clinical impact: The residual recurrence risk after afib-related stroke remains high despite secondary prevention therapy, emphasizing the need for improved risk stratification and novel secondary prevention strategies.

Source:

McCabe JJ, et al. (2025, May 21). JAMA Neurol. Residual Risk of Recurrent Stroke Despite Anticoagulation in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/40394992/