Atrial fibrillation (AF) is common in older adults and is strongly associated with ischemic stroke and transient ischemic attack (TIA). Anticoagulant therapy is essential for stroke prevention; however, long-term adherence is often suboptimal. In primary care, unrecognised treatment discontinuation may expose patients to avoidable cerebrovascular risk.A 76-year-old woman presented to primary care with sudden numbness in her left hand lasting approximately five minutes, which resolved completely. She had no prior similar episodes. Her medical history included atrial fibrillation and hypertension. On examination, she was alert, cooperative, and fully oriented. No focal neurological deficits were detected. Blood pressure was 160/100 mmHg. An electrocardiogram performed in the primary care setting confirmed atrial fibrillation. During medication review, the patient reported that she had stopped her prescribed anticoagulant therapy two years earlier on her own initiative, without consulting a physician. Given the presence of AF, disclosure of anticoagulant discontinuation, and a brief focal neurological deficit with full recovery, a provisional diagnosis of transient ischemic attack was considered. The patient was urgently referred to the emergency department for further evaluation. A key limitation of this case was the complete resolution of symptoms at presentation, which could have led to underestimation of risk without careful clinical assessment.While the association between AF and thromboembolic events is well established, this case demonstrates how treatment non-adherence may remain undetected until an acute presentation in primary care. It highlights routine medication review as a critical safety practice.This case reinforces the need for regular assessment of anticoagulant adherence in patients with AF. Even brief, self-limiting neurological symptoms should prompt urgent evaluation. Improving patient education and continuity of care may help prevent avoidable cerebrovascular events.TIA often precedes ischemic stroke. Early recognition in primary care enables timely referral and intervention, potentially reducing long-term neurological morbidity.Unmonitored discontinuation of anticoagulant therapy in patients with atrial fibrillation carries significant risk. Primary care plays a crucial role in identifying silent treatment gaps and initiating timely preventive action.