Abstract Number: Esoc2026lt91 Lt91 - Tailored Anticoagulation Switching in People With Stroke While on Anticoagulants (Tailswitch): Prospective Multicentre Cluster-Level Intervention Study

Abstract Background and aims Despite adequate anticoagulation, patients with atrial fibrillation (AF) still experience a 13% annual risk of recurrent stroke. We investigated in a multicentre prospective study whether a strategy based on DOAC prescribed according to plasma levels was superior to standard DOAC prescription in the prevention of recurrent stroke. Methods This study enrolled consecutive patients admitted with stroke while on DOAC for AF from 2024 to 2026 (currently) at 9 comprehensive stroke centres. Anticoagulation was restarted after stroke according to current guidelines, with DOAC chosen by the clinician. Three centers (RN, CE, BA) transitioned to a dosing strategy, measuring peak-trough DOAC plasma level after anticoagulation restart, switching DOAC until reaching therapeutic plasma levels (tailored group). The remaining centers maintained a standard of care policy, with prescription of DOAC without plasma level dosage. Recurrence of ischemic stroke, hemorrhagic stroke, TIA and major cardiovascular events were adjudicated by at 3 and 12-months through hot and cold pursuit. Results Overall 510 consecutive patients with stroke while on DOACs were consecutively included across all centers, 65 in the tailored group and 445 in the standard of care group. Mean age was 78 years, 50.5% male. No differences in terms of clinical features, cardiovascular risk factors and hyperacute treatment were found across groups. The 3-month recurrent stroke rate was 4.2% in tailored group and 5.9% in the standard of care group. Conclusions We expect to reach 85 patients in tailored group in Feb2026, finalizing the analysis for recurrent ischemic stroke and ICH in April 2026. Conflict of interest