Dabigatran vs. Aspirin for Secondary Prevention After Embolic Stroke of Undetermined Source　― Japanese Subanalysis of the RE-SPECT ESUS Randomized Controlled Trial ―

Embolic stroke of undetermined source: identification of patient subgroups for oral anticoagulation treatment

“…With regard to geographic regions, patients from Asia and central Europe seemed to benefit from dabigatran treatment with respect to stroke recurrence (6.0% versus 9.3%, hazard ratio 0.68; 95% CI: 0.44-1.03) and 4.3% versus 7.5% (hazard ratio 0.56, 95% CI: 0.30-1.06, respectively) compared to patients for North America or Western Europe. Furthermore, these findings are supported by a sub-analysis of the Japanese cohort of the RESPECT-ESUS trial (Toyoda et al, 2020), in which recurrent strokes and ischemic strokes occurred with a lower relative risk in Japanese patients on treatment with dabigatran (6.8% and 6.8%, respectively) compared with treatment with aspirin (12.7% vs. 12.3%, hazard ratio 0.55 and 0.56, 95% CI: 0.32-0.94, 0.33-0.97, respectively). Life threatening bleeding and major intracranial hemorrhage occurred in the group of dabigatran treated Japanese patients in 2.0% and 1.7%, while treatment with aspirin led to a relative risk of life-threatening bleeding in 4.3% (hazard ratio 0.46, 95% CI: 0.17-1.21) or major intracranial hemorrhage in 3.0% of patients (hazard ratio 0.55, 95% CI: 0.18-1.65).…”

Patent foramen ovale as the cause of recurrent embolic strokes. Case report

“…Так, анализ подгрупп больных, включенных в исследования RE-SPECT и NAVIGATE ESUS, показал потенциальную пользу от антикоагулянтной терапии при высокой вероятности бессимптомной ФП (пожилые со сниженной функцией почек, расширением левого предсердия и т.д.) [12][13][14]. С целью поиска скрытой ФП экспертами различных сообществ рекомендовано мониторирование результатов ЭКГ пациентов с ESUS в течение 24-72 ч [3,5,8,15,16].…”

Multicenter Observational Study on Detection of Atrial Fibrillation Using Insertable Cardiac Monitors in Patients With Cryptogenic Stroke in Japan : LOOK Registry - Study Design and Characteristics

“…The term "embolic stroke of undetermined source" (ESUS) has been proposed to describe CS that is not lacunar and not associated with proximal arterial stenosis or a recognized cardioembolic source, such as atrial brillation of the left ventricular thrombus [1]. Two international ESUS trials demonstrated that oral anticoagulants (rivaroxaban and dabigatran) were not superior to aspirin with regard to the prevention of recurrent stroke after ESUS [7,8], though a secondary analysis from the RE-SPECT ESUS study demonstrated that dabigatran was associated with a lower risk of recurrent stroke (compared to aspirin) among Japanese ESUS patients [9]. The con icting results of these studies highlight the di culty in diagnosing ESUS.…”

“…The con icting results of these studies highlight the di culty in diagnosing ESUS. In Japan, magnetic resonance imaging (MRI) is widely used in the diagnosis of ischemic stroke and a sub-analysis of the RE-SPECT ESUS study reported that MRI (administered at a prevalence of 99.8% in the Japanese cohort vs. 76.8% in the non-Japanese cohort) and MR angiography (92.8% vs. 41.8%) were implemented in the diagnosis of index strokes in Japan [9]. Japanese medical guidelines indicate that MRI is essential in the selection of candidates with CS for ICM implantation [6].…”