Журнал сосудистой медицины и хирургии

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Acute Ischemic Stroke Due to Anticoagulation Failure: New Challenging Issues in the DOACs Era

Francesco Janes1*, Fedra Kuris , Simone Lorenzut , Gian Luigi Gigli , Mariarosaria Valente1,2

Primary and secondary prevention of cardio embolic stroke is a key issue in Neurological and Cardiological clinical practice. Anticoagulation proved to be clearly effective, both with Vitamin K Anticoagulants and in the last years with Direct Oral Anticoagulants, in preventing acute ischemic stroke. The proportion of patients prescribed with these drugs is constantly rising in the last decades. However, the occurrence of an anticoagulation failure is responsible for a relevant and increasing proportion of ischemic strokes. In fact, those patients have a different and peculiar risk factors profile, require a more extensive diagnostic work-up to clarify stroke etiopathogenesis and need physicians to pay more attention to drug-to-drug and food-to-drug interactions. Moreover, reperfusion therapies are allowed only under specific conditions. The aim of this paper is to review the available evidence around acute ischemic strokes due to anticoagulation failure and to discuss their main clinical management issues. We draw attention on the need for a more widespread anticoagulation monitoring also with DOACs and to the growing evidence of their drug and food interactions. Data showed herein mean to be a useful and easy clinical guide in this subset of acute ischemic strokes.