Results of OCEANIC-STROKE Trial for Secondary Stroke Prevention

This episode, titled “Results of OCEANIC-STROKE Trial for Secondary Stroke Prevention,” features Ashkan Shoamanesh, MD, FRCPC, FESO, Eva Mistry, MD,Greg Albers, MD, and James Siegler, MD discuss the following question:

1. Share primary results from OCEANIC-STROKE trial that were recently presented at ISC 2026.
   1. Time to first occurrence of ischemic stroke and ISTH major bleeding
   2. Time to CV death, MI, etc.
   3. Safety results

The OCEANIC Stroke trial met its primary endpoint, showing a 26% relative risk reduction (about 2% absolute, NNT ≈ 50 at 1 year) in time to first ischemic stroke with asundexian versus placebo, on top of standard antiplatelet therapy. Beyond total stroke reduction, asundexian also significantly lowered all‑stroke, 3‑point MACE (CV death, nonfatal stroke, nonfatal MI), and disabling or fatal strokes (about a 30% reduction), meaning it prevented not just more events but the most serious ones. Remarkably, this benefit occurred without any increase in ISTH major bleeding, intracranial hemorrhage, hemorrhagic stroke, or even minor bleeding, despite two‑thirds of patients being on dual antiplatelet therapy. Clinicians on the panel described this safety–efficacy profile—strong protection from recurrent stroke in a high‑risk (~8% annual recurrence) population with no bleeding penalty—as unprecedented for an antithrombotic and potentially practice‑changing, especially for atherosclerotic patients traditionally limite

In the next episode, “Sub-group Analysis of OCEANIC-STROKE Trial for Secondary Stroke Prevention,” panelists will continue their discussion on results of OCEANIC-STROKE trial for secondary stroke prevention.