WSC 2025 | The limitations of anticoagulation for stroke prevention in patients with atrial fibrillation

The limitation of anticoagulation in patients with stroke is different. We have three categories of limitation. One is in the case of breakthrough stroke. So in a patient who was on the correct treatment with all the vascular risk factors controlled and they have a stroke. You have to offer your patient an alternative; they will ask what will happen if I have another stroke because they don’t want to go again through this stroke journey, which is terrible to recover from, to do it to gain back your independence. So there are now some studies ongoing about the left atrial appendage occlusion in patients with breakthrough strokes. There are two big trials, one in Switzerland, one in Israel. So sorry, the one in Switzerland, together with people from Israel, Austria, and Germany, and one in Canada. Very large trials called LAAOS-4. And we will see the results of this. But currently, we have already data from observational studies that closing the auricle on top of anticoagulation will improve, will reduce the risk of stroke. The current approach, in the past, it was that we changed anticoagulation treatment. So, or we add aspirin, but we did a study showing that both strategies are not useful, increase the risk of having recurrence and the risk of bleeding. Currently, based on the observational data, we tend to close the auricle. There are now big studies and upcoming about the filters in the carotid, but this is still some data; they are still – we have some safety data that it’s possible to put a filter in the bilateral filter in the carotid to block the thrombus or the embolus coming from the heart. We will start a large trial also in this, together led by Hamilton, so the INTERCEPT trial, so we have much more and more options to use on top of anticoagulation treatment.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.