Dabigatran vs. Aspirin for Embolic Stroke of Undetermined Source

Presumptive anticoagulation for embolic stroke of undetermined source (ESUS) is generally not justified, but specific subgroups may derive benefit.

Oral anticoagulants have an established role in preventing cardioembolic stroke in patients with known nonvalvular atrial fibrillation. But even if the infarct pattern suggests an embolic mechanism, current guidelines recommend antiplatelet therapy over presumptive anticoagulation unless a specific embolic source is identified. Availability of newer oral anticoagulants has renewed interest in evaluating the suitability of presumptive anticoagulation.

In the industry-sponsored RE-SPECT ESUS trial, 5390 ESUS patients were randomly assigned to dabigatran or aspirin. ESUS was defined as a nonlacunar stroke without significant extracranial or intracranial atherosclerosis with less than 6 minutes of atrial fibrillation demonstrated during at least…

Reviewing Author

Anthony S. Kim, MD

Disclosures

Grant/Research SupportNIH/National Institute of Neurological Disorders and Stroke; NIH/National Center for Advancing Translational Sciences

Anthony S. Kim, MD

Disclosures

Grant/Research SupportNIH/National Institute of Neurological Disorders and Stroke; NIH/National Center for Advancing Translational Sciences

Dabigatran vs. Aspirin for Embolic Stroke of Undetermined Source

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Reviewing Author