Sub-group Analysis of OCEANIC-STROKE Trial for Secondary Stroke Prevention

In this episode “Sub-group Analysis of OCEANIC-STROKE Trial for Secondary Stroke Prevention,”Ashkan Shoamanesh, MD, FRCPC, FESO James Siegler, MD, Greg Albers, MD, Eva Mistry, MD explore the following question:

1. Can you discuss results of subgroup analysis of OCEANIC-STROKE trial that were presented at ISC 2026?

The panel emphasizes that, in a large 12,000+ patient global trial, the critical question is whether asundexian’s benefit is consistent across diverse subgroups, and the data show that it is: treatment effects favored asundexian regardless of sex, age, use of thrombolysis or thrombectomy, DAPT vs monotherapy, or specific non‑cardioembolic stroke subtype (including TIA). Very large subtype cohorts were available—about 5,000 with large‑artery atherosclerosis, 3,500 with stroke of undetermined etiology (ESUS‑like), and 2,600 with small‑vessel (lacunar) disease—making the subgroup findings unusually robust. Contrary to expectations from phase 2, there was no clear heterogeneity of effect; numerically, ESUS patients had the largest relative and absolute risk reductions, but this remains hypothesis‑generating. Overall, the consistent benefit across mechanisms, including in enriched lacunar populations, suggests factor XIa inhibition may be broadly useful for non‑cardioembolic secondary prevention, even in real‑wor

The next episode in this series, “Place of Factor XI Inhibitors in Stroke Prevention in Clinical Practice,” features the panelists concluding their conversation on secondary stroke prevention.