WSC 2025 | Trials investigating treatment options to prevent breakthrough strokes

Yeah, breakthrough strokes are a very important issue and definitely something we need more evidence on. There are ongoing studies, very interesting studies on things that we can do. For example, the ELAPSE study for the use of atrial appendage closure in patients with recurrent stroke despite being on DOACs or anticoagulation. And there are also observational evidence. The [inaudible] study, for example, from Italy is also collecting observational evidence on these patients. Of course, there are things we always should do. We should assess compliance before we have the evidence from this trial. So we should always assess compliance. Non-compliance is a main cause of recurrent stroke in these patients. We can use the levels also to help on this. But of course, we can also ask the patient and try to collect good history on how compliant the patient is. Then, of course, we need to assess other possible etiologies. There is definitely something that contributes to a part of the cases. So having something else than AF, for example, small vessel disease, atherosclerotic disease, unstable plaques and cancer and other etiologies that can contribute to this persistent risk, this is also something to consider. And then there are maybe other strategies that these new trials will help us to identify that can improve reducing the recurrence rates in these patients, but for that we definitely need more evidence.

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