Association of ischaemic stroke/TIA with subsequent oral anticoagulant adherence in patients with atrial fibrillation: a scoping review

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.