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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

When anticoagulant therapy is not enough: recurrent stroke

Filippo Stazi1

  • 1UOS Week Cardiology, UOC Cardiology, San Giovanni Addolorata Hospital, Via dell'Amba Aradam 8, 00184 Rome, Italy.

European Heart Journal Supplements : Journal of the European Society of Cardiology
|May 8, 2026
PubMed

Insights

Patients with atrial fibrillation (AF) face a high risk of recurrent stroke even on oral anticoagulants. New secondary prevention strategies are crucial for managing this residual risk.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Atrial fibrillation (AF) patients on oral anticoagulants (OAT) have a significant residual risk of recurrent ischemic stroke (~4% annually).
  • This risk escalates to ~9% annually for patients experiencing stroke despite OAT, necessitating enhanced secondary prevention strategies.

Purpose of the Study:

  • To identify high-risk patients for recurrent ischemic stroke in AF.
  • To explore and evaluate existing and novel secondary prevention strategies for AF patients post-stroke.

Main Methods:

  • Review of current OAT optimization, rhythm-control approaches, and non-pharmacological interventions like left atrial appendage occlusion.
  • Assessment of emerging therapies, including novel factor XI and XIa inhibitors.
  • Analysis of the ineffectiveness of switching anticoagulants or adding antiplatelet therapy.

Main Results:

  • Current strategies involve excluding non-AF causes, optimizing OAT, early initiation post-stroke, and aggressive rhythm control.
  • Left atrial appendage occlusion is under evaluation for secondary prevention efficacy.
  • Novel factor XI/XIa inhibitors show promise for comparable efficacy and improved safety over DOACs.
  • Switching anticoagulants or adding antiplatelet agents is ineffective.

Conclusions:

  • Recurrent stroke mechanisms in AF patients on OAT are complex, requiring individualized treatment plans.
  • Optimizing OAT, considering novel anticoagulants, and exploring interventions like LAA occlusion are key areas for future research and clinical practice.

Keywords:
Atrial fibrillationIschaemic strokeOral anticoagulant therapy

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