Association of ischaemic stroke/TIA with subsequent oral anticoagulant adherence in patients with atrial fibrillation: a scoping review.
AA, S., RD, T., MA, D.V., M, H., NE, G., & PS, L. (2026). Association of ischaemic stroke/TIA with subsequent oral anticoagulant adherence in patients with atrial fibrillation: a scoping review.. BMJ open. https://doi.org/10.1136/bmjopen-2025-112736
AA S, RD T, MA DV, M H, NE G, PS L. Association of ischaemic stroke/TIA with subsequent oral anticoagulant adherence in patients with atrial fibrillation: a scoping review.. BMJ open. 2026; doi: 10.1136/bmjopen-2025-112736
AA S, RD T, MA DV, et al. Association of ischaemic stroke/TIA with subsequent oral anticoagulant adherence in patients with atrial fibrillation: a scoping review.[J]. BMJ open. 2026. DOI: 10.1136/bmjopen-2025-112736.
@article{aa2026,
author = {Shukkoor AA and Turgeon RD and De Vera MA and Harrison M and George NE and Loewen PS},
title = {Association of ischaemic stroke/TIA with subsequent oral anticoagulant adherence in patients with atrial fibrillation: a scoping review.},
journal = {BMJ open},
year = {2026},
doi = {10.1136/bmjopen-2025-112736},
note = {PMID: 42331577},
}
TY - JOUR AU - Shukkoor AA AU - Turgeon RD AU - De Vera MA AU - Harrison M AU - George NE AU - Loewen PS TI - Association of ischaemic stroke/TIA with subsequent oral anticoagulant adherence in patients with atrial fibrillation: a scoping review. T2 - BMJ open PY - 2026 DO - 10.1136/bmjopen-2025-112736 AN - PMID:42331577 ER -
OBJECTIVES: This study aimed to investigate the association and potential causal relationship between ischaemic stroke/transient ischaemic attack (TIA) and oral anticoagulant (OAC) adherence using Bradford Hill's criteria and to determine the factors influencing OAC adherence following ischaemic stroke in atrial fibrillation (AF) patients. DESIGN: We conducted a scoping review. DATA SOURCES: MEDLINE, Embase and Web of Science from inception up to March 2026. RESULTS: The analysis included 43 studies on OAC adherence across different phases: initiation (n=1), implementation (n=15), implementation and discontinuation (n=7) and persistence (n=20). Of these, 26 studies showed a positive association between ischaemic stroke history and OAC adherence while one showed a negative association. The evaluation of the body of evidence suggests a mixed association between ischaemic stroke and subsequent OAC adherence. While causality is not definitively established due to the observational nature of the included studies, they fulfil several of the classic Bradford Hill criteria, including temporality, consistency, biological gradient, coherence and plausibility. Factors like age, chronic obstructive pulmonary disease, cancer, heart failure, hypertension, myocardial infarction, anaemia, dementia, smoking, prior warfarin use, education level, stroke severity and recurrence were associated with decreased OAC adherence, whereas experiencing a first stroke was associated with increased adherence. CONCLUSIONS: Existing evidence shows mixed associations between ischaemic stroke and OAC adherence and causality also remains inconclusive. There are multiple factors that modify this relationship. Further observational studies using causality methods are needed to definitively confirm this relationship.