Overview from the 2026 International Stroke Conference - Part 2

In part two of the series, Dr. Andy Southerland and Dr. Seemant Chaturvedi break down key takeaways from the OCEANIC‑STROKE trial. 

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Read more about the OCEANIC-STROKE trial. 

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Dr. Andy Southerland: 

Hello everyone. This is Andy Southerland from the University of Virginia. For today's Neurology Minute, I've just been speaking with my colleague, Seemant Chaturvedi from the University of Maryland, about exciting trials presented at this year's 2026 International Stroke Conference from the American Heart Association, American Stroke Association. And the one we want to discuss for today's Neurology Minute in brief was the OCEANIC-STROKE trial. This was a very large international trial looking at the use of a novel antithrombotic agent, a Factor XI inhibitor, compared to placebo as an adjunct to our traditional antiplatelet therapies for secondary stroke prevention. And it was received with quite a bit of excitement. So Seemant, tell us in brief, what did we learn from OCEANIC-STROKE?

Dr. Seemant Chaturvedi: 

One new class of agents, which is being tested are the Factor XIa inhibitors. And this has a unique mechanism of action, and it's believed that it can reduce thrombotic events without causing an increase in bleeding, which would be truly a major breakthrough. And so in OCEANIC-STROKE, over 12,000 patients were enrolled with either stroke or high-risk TIA within 72 hours of the last event. And the trial found that patients who had fairly mild strokes with a median NIH score of two, that when you add the asundexian 50 milligrams per day on top of either dual antiplatelet or single antiplatelet therapy, that there was an improved outcome and reduction in stroke with asundexian. There was a 2.2% absolute reduction in ischemic stroke, 26% in relative terms. Stroke, MI, and vascular death was also reduced with asundexian, as was disabling stroke. An exciting finding was that major bleeding was not increased with asundexian.

And so this confirmed the preclinical hypothesis. And so I think this was a significant result in terms of reducing recurrent ischemic stroke without increasing bleeding. And so I think we eagerly await the full publication, and I think it could be applicable to many of the patients that we see in our clinical practice.

Dr. Andy Southerland: 

So asundexian, folks, you'll hear more about this as the drug hopefully comes on the market and we see the full primary publication of this OCEANIC-STROKE trial, but exciting nonetheless to have a possible new treatment to help us reduce the risk of recurrent stroke for our patients. So Seemant, thanks so much again for joining us for today's Neurology Minute. And I encourage all of our listeners, as always, to listen to the full podcast interview ain The Neurology Podcast. Seemant, thanks for joining us.

Dr. Seemant Chaturvedi: 

My pleasure.