Ali Mahdi: DAPT Use in OCEANIC-STROKE And Its Interaction with Asundexian
Ali Mahdi, Pharmacist at MISTRY HEALTH CARE PRIVATE LIMITED, Medical Representative at União Química National Pharmaceutical Company, shared a post on LinkedIn:
“ESC Congress 2026: DAPT use in OCEANIC-STROKE and its interaction with asundexian
New data presented at ESC Congress 2026 examined the use of dual antiplatelet therapy (DAPT) during the first 90 days after randomisation in OCEANIC-STROKE, providing additional insight into which patients received DAPT and whether background antiplatelet strategy influenced the effect of asundexian.
Clinical highlights
- Trial: OCEANIC-STROKE (NCT05686070) was a Phase III, double-blind, randomized trial enrolling 12,327 adults with a recent non-cardioembolic ischemic stroke or high-risk TIA. Participants were randomized to asundexian 50 mg once daily or placebo, in addition to planned single or dual antiplatelet therapy.
- DAPT exposure: Approximately 63% of participants were planned to receive DAPT at randomisation, reflecting contemporary secondary stroke-prevention practice in the early post-event period.
- Patient population: Mean age was approximately 68 years, 67% were male, and 95% presented with ischemic stroke rather than TIA. Large-artery atherosclerosis accounted for approximately 43% of index strokes, small-vessel disease for 22%, and undetermined etiology for approximately 30%.
- Efficacy: In the overall OCEANIC-STROKE population, ischemic stroke occurred in 6.2% with asundexian vs 8.4% with placebo (cause-specific HR 0.74, 95% CI 0.65–0.84; P less than 0.001), corresponding to a 26% relative reduction.
- Interaction with antiplatelet strategy: The benefit of asundexian was reported to be consistent across planned DAPT and single-antiplatelet therapy, suggesting that the treatment effect was not confined to one background antiplatelet strategy.
- Safety: Major bleeding was similar between groups (1.9% with asundexian vs 1.7% with placebo; HR 1.10, 95% CI 0.85–1.44), despite substantial use of concomitant antiplatelet therapy.
- Mechanism: Asundexian is an oral factor XIa inhibitor, targeting the intrinsic coagulation pathway while aiming to preserve tissue-factor–mediated hemostasis. This provides a mechanistically distinct approach to reducing thrombosis without directly inhibiting platelet function.
The bottom line:
These data add an important layer to the interpretation of OCEANIC-STROKE: the reduction in recurrent ischemic stroke with FXIa inhibition was observed across different background antiplatelet strategies, including early DAPT.
The findings support further evaluation of how anticoagulation and antiplatelet therapy can be combined to optimize the balance between ischemic protection and bleeding risk after non-cardioembolic stroke.
ESC 365 – Dual antiplatelet therapy (DAPT) during the first 90 days post-randomisation in OCEANIC-STROKE: participant characteristics and interaction with asundexian.”
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