Macha K, et al. - Given that severity of stroke and clinical course are affected by the quality of anticoagulation at the time of stroke onset in patients with ischemic stroke on therapy with vitamin K antagonists, researchers explored clinical data for patients using direct oral anticoagulants (DOACs). They assessed registry data of all patients admitted with acute cerebral ischemia between November 2014 and October 2017 while taking oral anticoagulants for atrial fibrillation. Included were 460 patients. Investigators found that the anticoagulation activity assessed on admission by specific DOAC plasma levels was related to the severity of the stroke and occlusion of large vessels. Large vessel occlusion was independently predicted by low DOAC levels.