{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada",
        "Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Aashiq Ahamed Shukkoor"
    },
    {
      "affiliations": [
        "Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada",
        "Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada",
        "UBC Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada",
        "Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Ricky D Turgeon"
    },
    {
      "affiliations": [
        "Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada",
        "Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Mary A De Vera"
    },
    {
      "affiliations": [
        "Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada",
        "Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Mark Harrison"
    },
    {
      "affiliations": [
        "Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Nimmy Elizabeth George"
    },
    {
      "affiliations": [
        "Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada",
        "Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada",
        "UBC Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada"
      ],
      "name": "Peter S Loewen"
    }
  ],
  "title": "Association of ischaemic stroke/TIA with subsequent oral anticoagulant adherence in patients with atrial fibrillation: a scoping review",
  "uid": "6aa02c66-4dc5-5a7e-bf9e-217bca870c7b"
}