Mira Katan, MD, MSc, FESO, University Hospital of Zurich, Zurich, Switzerland, discusses the use of biomarkers to guide secondary stroke prevention with anticoagulants. Using the TOAST classification, around 30% of strokes are grouped as cryptogenic and without understanding the underlying stroke etiology, optimal secondary prevention techniques are not clear. More recently, a subgroup known as ‘embolic stroke of unknown source’ (ESUS) has been defined. Studies have shown that a large proportion of patients with ESUS have underlying atrial fibrillation (AF) and may therefore benefit from direct oral anticoagulant use. Dr Katan highlights the promise of atrial natriuretic peptide (ANP) as a blood-based biomarker to identify patients in the ESUS group with undiagnosed paroxysmal AF and other covert cardio-embolic sources of stroke. Several studies have demonstrated ANP to have a good predictive ability. This interview took place at the European Stroke Organisation Conference (ESOC), 2021.
