The optimal strategy for secondary stroke prevention in patients with atrial fibrillation who suffer from an ischemic stroke despite oral anticoagulation is unclear. Accumulating evidence suggests that this population are at higher risk for future recurrence than patients with atrial fibrillation who were naïve to anticoagulants before stroke. Daniela Poli, MD, Azienda Ospedaliera Universitaria Careggi, Florence, Italy, talks on this issue and what more data is needed to develop guidelines for optimal management. The widespread introduction of direct oral anticoagulants (DOACs) must also be considered, but there is currently a lack of data on if these agents may lead to better outcomes in patients with stroke while on anticoagulation. This interview took place at the ESOC 2022 congress in Lyon, France.