This case series described two patients who were infected with SARS-CoV-2 who had thrombotic strokes during ongoing anti-coagulation treatment for atrial fibrillation stroke prophylaxis. 

• Both cases involved men, ages 74 and 84 years old, each with multiple cardiovascular diseases, including atrial fibrillation. Both adequately treated for this condition.
• Patient 1 was admitted for respiratory symptoms, diagnosed with COVID-9. On Day 9, having neurological symptoms and brain MRI revealed acute ischemic stroke in multiple vascular areas. his conditional worsened and he died on Day 18 of hospitalizations.
• Patient 2 was admitted for influenza-like illness and confusion. COVID-9 positive. Had nonfluent aphasia at admission. Brain CT scan revealed many recent ischemic infarctions in different vascular areas, and brain MRI  confirmed this finding
• Neither patient had non–central nervous system thrombotic events (e.g., pulmonary embolisms, abdominal visceral infarction)
• Given the increasing realization that COVID-19 might be associated with hypercoagulability, the concurrent presence of anti-coagulation with direct oral anticoagulants should not be reassuring as preventive.