Assessing Susceptibility to Recurrent Stroke: Alexander Merkler, MD, MS

WATCH TIME: 2 minutes

"Our job as clinicians and neurologists is to try to identify why the person had the first stroke, identify the cause of the stroke, and specifically target a risk factor that can reduce the risk of another stroke."

The phase 3 NAVIGATE-ESUS trial (NCT02313909), led by Alexander Merkler, MD, MS, compared the effects of rivaroxaban (Xarelto; Janssen), an anticoagulant, to aspirin, an antiplatelet, in reducing risk of recurrent stroke in those with neuroimaging-confirmed embolic strokes of undetermined source (ESUS). A recently published exploratory analysis from this trial specifically looked at those with ESUS who had left ventricular (LV) dysfunction.

Over a median follow-up of 10.4 months, the primary outcome of recurrent stroke or systemic embolism occurred in 321 participants (4.9% per year). When comparing the 2 treatments, event rates were 2.4% per year (95% CI, 1.1-5.4) in those with LV dysfunction assigned to rivaroxaban versus 6.5% (95% CI, 4.0-11) in those on aspirin. Merkler, assistant professor of neurology, Weill Cornell Medicine, told NeurologyLive that about 25% of ischemic strokes in the United States each year are recurrent, making them a highly prevalent issue within the space.

Merkler shared his thoughts on the troublesome rate of recurrent strokes and whether certain types of stroke are associated with recurrent stroke or systemic embolism.