Het nut van antiaggregantia en anticoagulantia na een embolische beroerte van ongekende oorsprong

Abstract

The use of antiplatelet agents and anticoagulants after embolic stroke of undetermined source “Embolic stroke of undetermined source” (ESUS) was introduced in 2014 to classify a population with ischemic stroke, caused by an embolism of unknown origin. Atrial fibrillation (AF) is a possible cause for this embolism. As detection of AF implies secondary prevention with anticoagulants rather than acetylsalicylic acid, the hypothesis arose that anticoagulants are superior to antiplatelet therapy in secondary prevention after ESUS. This article summarizes the current evidence about the use of anticoagulants in secondary prevention after ESUS. Rivaroxaban and dabigatran were not superior to acetylsalicylic acid in secondary prevention of stroke in patients with ESUS and were even associated with a higher risk of bleeding. Ongoing trials compare apixaban with acetylsalicylic acid in secondary prevention of stroke in patients with diagnosed ESUS and concomitant risk factors for AF. Currently, there is no evidence to support the routine use of oral anticoagulants in secondary prevention of stroke after ESUS.