Atrial fibrillation (AF) is a leading cause of cardioembolic stroke, which is often fatal or disabling. Prevention of stroke is crucial in AF management, and anticoagulation with non-vitamin K oral anticoagulants (NOACs) is the mainstay of AF management for stroke prevention. Because NOAC prescriptions have been surging worldwide, the development of acute ischemic stroke in patients with AF who receive NOAC treatment is an increasingly important issue in clinical practice. Moreover, these patients show a high risk of recurrence, with more than a 50% higher risk, than do patients with AF and no prior anticoagulation therapy. Careful evaluation is mandatory to determine possible causes of ischemic stroke during NOAC therapy. Differentiation of AF-unrelated stroke and demonstration of combined cardiac disease/systemic coagulopathy are important in these patients and may provide improved results in their treatment. In addition, ensuring appropriate dosing and good adherence to NOAC treatment is important. Cardioembolism, despite sufficient anticoagulation and no other causes, is the most common and challenging complication because switching to anticoagulants or adding antiplatelets to the treatment regimen does not reduce the risk of recurrent stroke, and there are no guidelines for this specific situation. This review article aimed to present the most updated data on the prevalence, causes, and secondary prevention strategies, specifically focusing on non-pharmacological approaches, together with relevant cases of AF in patients who developed ischemic stroke on NOAC therapy.

中文翻译：

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接受非维生素 K 口服抗凝剂的心房颤动患者发生缺血性中风：原因和预防策略。

心房颤动 (AF) 是心源性中风的主要原因，通常是致命的或致残的。预防中风在 AF 管理中至关重要，使用非维生素 K 口服抗凝剂 (NOAC) 进行抗凝是预防中风的 AF 管理的主要手段。由于 NOAC 处方在全球范围内激增，接受 NOAC 治疗的 AF 患者发生急性缺血性卒中成为临床实践中日益重要的问题。此外，这些患者复发风险高，比既往未接受抗凝治疗的 AF 患者高出 50% 以上。必须仔细评估以确定 NOAC 治疗期间缺血性卒中的可能原因。鉴别与 AF 无关的卒中和合并心脏病/全身性凝血病的证据对这些患者很重要，并可能在他们的治疗中提供更好的结果。此外，确保适当的剂量和良好的 NOAC 治疗依从性也很重要。尽管进行了充分的抗凝治疗且没有其他原因，但心源性栓塞是最常见和最具挑战性的并发症，因为改用抗凝剂或在治疗方案中加入抗血小板药物并不能降低卒中复发的风险，并且没有针对这种特定情况的指南。这篇评论文章旨在提供有关流行率、原因和二级预防策略的最新数据，特别关注非药物方法，