{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T12:11:51Z","timestamp":1778069511179,"version":"3.51.4"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"Supplement_5","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Despite the use of oral anticoagulants, the residual risk of recurrent ischaemic stroke in patients with atrial fibrillation (AF) is \u223c4% per year; however, in patients who experience a stroke despite oral anticoagulant therapy (OAT), this risk approaches 9% per year. It is therefore essential to identify patients at higher risk and to develop new strategies for secondary prevention. These strategies include the exclusion of non-AF-related causes, optimization of OAT and its early initiation after stroke, as well as an aggressive rhythm-control approach. Additional non-pharmacological options include surgical or percutaneous left atrial appendage occlusion, although its effectiveness in secondary prevention after ischaemic stroke is still under evaluation. Novel pharmacological therapies targeting factors XI and XIa are currently under investigation and may provide comparable efficacy with improved safety compared with direct oral anticoagulants. Conversely, switching from one anticoagulant to another or adding antiplatelet therapy is completely ineffective. The mechanisms underlying recurrent stroke despite anticoagulant therapy are therefore complex, making an individualized, patient-specific approach mandatory.<\/jats:p>","DOI":"10.1093\/eurheartjsupp\/suag052","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T12:54:30Z","timestamp":1772283270000},"page":"v164-v168","source":"Crossref","is-referenced-by-count":0,"title":["When anticoagulant therapy is not enough: recurrent stroke"],"prefix":"10.1093","volume":"28","author":[{"given":"Filippo","family":"Stazi","sequence":"first","affiliation":[{"name":"UOS Week Cardiology, UOC Cardiology, San Giovanni Addolorata Hospital , Via dell'Amba Aradam 8, 00184 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"2026050607121118600_suag052-B1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1002\/ana.25917","article-title":"Investigators of the Swiss Stroke Registry. 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A systematic review and meta-analysis","volume":"82","author":"McCabe","year":"2025","journal-title":"JAMA Neurol"},{"key":"2026050607121118600_suag052-B3","doi-asserted-by":"crossref","first-page":"281\u20137a","DOI":"10.1093\/eurheartj\/ehu307","article-title":"Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES","volume":"36","author":"Vanassche","year":"2015","journal-title":"Eur Heart J"},{"key":"2026050607121118600_suag052-B4","doi-asserted-by":"crossref","first-page":"e924","DOI":"10.1212\/WNL.0000000000005126","article-title":"Atrial fibrillation detected after stroke is related to a low risk of ischemic stroke recurrence","volume":"90","author":"Sposato","year":"2018","journal-title":"Neurology"},{"key":"2026050607121118600_suag052-B5","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/17474930241270443","article-title":"Anticoagulation strategy for patients presenting with ischemic strokes while using a direct oral anticoagulant: a systematic review and meta-analysis","volume":"20","author":"Mota Telles","year":"2025","journal-title":"Int J Stroke"},{"key":"2026050607121118600_suag052-B6","doi-asserted-by":"crossref","first-page":"2411","DOI":"10.1056\/NEJMoa2303048","article-title":"Early versus later anticoagulation for stroke with atrial fibrillation","volume":"388","author":"Fischer","year":"2023","journal-title":"N Engl J Med"},{"key":"2026050607121118600_suag052-B7","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1016\/S0140-6736(22)00456-1","article-title":"Safety of the oral factor XIa inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF): a multicentre, randomised, double-blind, double-dummy, dose-finding phase 2 study","volume":"399","author":"Piccini","year":"2022","journal-title":"Lancet"},{"key":"2026050607121118600_suag052-B8","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1056\/NEJMoa2019422","article-title":"Early rhythm-control therapy in patients with atrial fibrillation","volume":"383","author":"Kirchhof","year":"2020","journal-title":"N Engl J Med"},{"key":"2026050607121118600_suag052-B9","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S1474-4422(22)00436-7","article-title":"Early rhythm-control therapy for atrial fibrillation in patients with a history of stroke: a subgroup analysis of the EAST-AFNET 4 trial","volume":"22","author":"Jensen","year":"2023","journal-title":"Lancet Neurol"},{"key":"2026050607121118600_suag052-B10","doi-asserted-by":"crossref","first-page":"e023391","DOI":"10.1161\/JAHA.121.023391","article-title":"Risks and benefits of early rhythm control in patients with acute strokes and atrial fibrillation: a multicenter, prospective, Randomized Study (the RAFAS Trial)","volume":"11","author":"Park","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2026050607121118600_suag052-B11","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1056\/NEJMoa2101897","article-title":"Left atrial appendage occlusion during cardiac surgery to prevent stroke","volume":"384","author":"Whitlock","year":"2021","journal-title":"N Engl J Med"},{"key":"2026050607121118600_suag052-B12"}],"container-title":["European Heart Journal Supplements"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurheartjsupp\/advance-article-pdf\/doi\/10.1093\/eurheartjsupp\/suag052\/67303080\/suag052.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartjsupp\/article-pdf\/28\/Supplement_5\/v164\/67303080\/suag052.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartjsupp\/article-pdf\/28\/Supplement_5\/v164\/67303080\/suag052.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T11:12:21Z","timestamp":1778065941000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurheartjsupp\/article\/28\/Supplement_5\/v164\/8514599"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":12,"journal-issue":{"issue":"Supplement_5","published-online":{"date-parts":[[2026,3,11]]},"published-print":{"date-parts":[[2026,5,6]]}},"URL":"https:\/\/doi.org\/10.1093\/eurheartjsupp\/suag052","relation":{},"ISSN":["1520-765X","1554-2815"],"issn-type":[{"value":"1520-765X","type":"print"},{"value":"1554-2815","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,3,11]]}}}