Which Patients with Embolic Stroke of Undetermined Source Benefit from Anticoagulation Over Antiplatelet Therapy?

Multiple large, randomized trials comparing anticoagulation with antiplatelet therapy to prevent recurrent stroke after embolic stroke of undetermined source (ESUS) have had neutral findings. However, subpopulations of ESUS patients with varied mechanisms of stroke could have differential responses to these antithrombotic options. To shed light on this question, investigators conducted a systematic review and meta-analysis of the literature and identified 7 randomized controlled trials of ESUS patients with a total of 14,804 participants randomized to anticoagulation or antiplatelet therapy, including studies limited to ESUS patients with patent foramen ovale (PFO) or atrial cardiopathy.

In keeping with previous trials, the pooled rates of r…