Stroke management in AF patients typically involves anticoagulation therapy with vitamin K antagonists (VKA) or direct oral anticoagulants (DOACs). However, recurrent ischemic strokes remain a significant clinical challenge, with high mortality risk. Current management options include continuing or switching DOACs, adding antiplatelet therapy, or left atrial appendage closure, but limited data make it difficult to recommend a preferred approach.

A systematic literature search was conducted in PubMed, Cochrane, and Web of Science, yielding 9987 studies. After screening, 13 relevant studies were selected based on their focus on recurrent stroke in anticoagulated patients. The studies included data on stroke recurrence and ICH rates and explored interventions such as switching from a DOAC to a VKA, switching between DOACs, or adjusting medication dosage. The study was registered in PROSPERO (ID: CRD42024523312).

A total of 13,635 patients with a mean age of 77.5 years were included, 47% of whom were female. The follow-up period averaged 11.3 months. Among the patients analyzed, the recurrent stroke rate was 7.1%, and the ICH rate was 6.0%. Management strategies varied, with some patients switching to VKAs or other DOACs, increasing the dose, or maintaining their current anticoagulation. The full results of the meta-analysis will be presented at the conference, offering deeper insights into the effectiveness of each strategy.

Despite extensive research, no definitive consensus has been reached on the optimal approach for recurrent stroke in anticoagulated patients. This meta-analysis aims to offer further insight, but the need for individualized treatment and larger studies remains essential.