Condition: Ischemic Stroke · Atrial Fibrillation · Sponsor: Insel Gruppe AG, University Hospital Bern
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and cardioembolic stroke due to AF is its major complication. Direct oral anticoagulants (DOAC) reduce the risk of cardioembolism in patients with AF. Despite DOAC therapy, there is a significant residual stroke risk of 1-2%/year. Recent data from the Swiss Stroke Registry found 38% of patients with AF and ischemic stroke were on prior anticoagulant therapy (approximately 400 patients per year in Switzerland). The investigators found in a prior observational study, that patients with AF who have ischemic stroke despite anticoagulation are at increased risk of having another ischemic stroke (HR 1.6; 95% confidence interval, CI 1.1-2.1). Combining observational data from 11 international stroke centres, the investigators found that the majority of ischemic strokes despite anticoagulation in patients with AF is "breakthrough" cardioembolism (76% of patients) and only a minority of 24% is related to other causes unrelated to AF. Optimal secondary prevention strategy is unknown. The investigators have conducted two independent observational studies including together \>4000 patients but did not identify any strategy (e.g. switch to different DOAC, additional antiplatelet therapy) that seems superior. A recent randomized controlled trial on surgical occlusion of the left atrial appendage (LAAO) found that LAAO may provide additional protection from ischaemic stroke in addition to oral anticoagulation. Triggered …
This description comes directly from the study's public registry record.
Lorenz Räber, Prof., MD, PhD · +41316320929 · Lorenz.Raeber@insel.ch
David Seiffge, Prof., MD · +41316640509 · david.seiffge@insel.ch
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| UCLouvain - Cliniques universitaires Saint-Luc | Brussels, Brussels Capital, Belgium | Recruiting |
| AZ Sint Jan Brugge | Bruges, Belgium | Recruiting |
| Brussels University Hospital | Brussels, Belgium | Recruiting |
| HUmani CHU Charleroi-Chimay | Charleroi, Belgium | Recruiting |
| Universitair Ziekenhuis (UZ) Leuven | Leuven, Belgium | Recruiting |
| CHU Liège Sart-Tilman | Liège, Belgium | Recruiting |
| Asklepios Klinik Altona | Hamburg, Free and Hanseatic City of Hamburg, Germany | Recruiting |
| Universitätsklinikum Leipzig | Leipzig, Leipzig, Germany | Recruiting |
| Universitätsmedizin Mannheim | Mannheim, Mannheim, Germany | Recruiting |
| UKSH, Campus Lübeck | Lübeck, Schleswig-Holstein, Germany | Recruiting |
| Charité-Universitätsmedizin Berlin | Berlin, State of Berlin, Germany | Recruiting |
| Universitätsklinikum Bonn | Bonn, Germany | Recruiting |
+ 18 more locations — full list on the registry record.
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Source record: clinicaltrials.gov/study/NCT05976685