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Safer Paths Better Outcomes: Advancing Secondary Stroke Prevention Through Factor XIa Innovation - Masterclass

Stroke medicine

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Description

This program is supported by an independent education grant from Bayer. This education program is only available to healthcare professionals in the USA.

In this on-demand masterclass, leading stroke prevention experts Dr. Jeffrey L. Saver and Dr. Craig Beavers translate high-impact evidence from the AHA/ASA guidelines and landmark trials into actionable clinical decisions. Through concise case-based simulations, faculty will explore the integration of novel Factor XIa inhibition and showcase pharmacist-led strategies for medication reconciliation and long-term adherence.

The session features an interview with a patient advocate. By bridging the gap between emerging trial data and real-world patient perspectives, this session equips multidisciplinary teams with the tools to optimize antithrombotic management and improve long-term outcomes for stroke survivors.

Accreditation: For Pharmacists, AffinityCE designates this activity for 1 CEU

Accredited modules for other specialties are available using the following links: Module 1, Module 2, Module 3, Module 4.

Session Highlights

Evidence-Based Antithrombotic Selection: Master the timing and selection of therapy for minor non-cardioembolic ischemic stroke and high-risk TIA, applying AHA/ASA guidelines and landmark trial data (POINT, CHANCE, THALES) that support early, short-term Double Antiplatelet Therapy (DAPT) for 21–30 days to reduce 90-day recurrence.
Precision Medicine via Genotyping: Evaluate the impact of CYP2C19 loss-of-function alleles on clopidogrel responsiveness; for these carriers, evidence from the CHANCE 2 trial suggests that DAPT with ticagrelor and aspirinis more effective than clopidogrel-based regimens in reducing recurrent stroke risk.
Novel Mechanisms in Factor XIa Inhibition: Interpret emerging Phase II and III clinical evidence (such as PACIFIC-STROKE and OCEANIC-STROKE) on Factor XIa inhibitors, which aim to uncouple pathologic thrombosis from hemostasis to potentially reduce ischemic events without significantly increasing major bleeding.
Tailored Cardioembolic Management: Utilize an infarct-size-based schedule for initiating Direct Oral Anticoagulants (DOACs) in patients with atrial fibrillation—starting earlier (within 48 hours) for small/moderate infarcts and later (days 6–7) for large infarcts—to balance the risks of recurrent ischemia and hemorrhagic transformation.
Pharmacist-Led Care Coordination: Implement multidisciplinary, pharmacist-inclusive strategies to optimize transitions of care, utilizing comprehensive medication management and education to address socioeconomic and communication barriers that impede patient adherence.

Who Should Watch

Pharmacists
Neurologists
Multidisciplinary stroke care teams
Primary care physicians
Critical care physicians
Hospitalists
Advanced practice providers
Nurses
Care managers involved in multidisciplinary post-stroke care

Presented by

Jeffrey L. Saver, MD, FAHA, FAAN, FANA, is a Distinguished Professor and Director of the UCLA Comprehensive Stroke and Vascular Neurology Program. A world-renowned expert in stroke treatment and prevention, he has authored over 870 research articles and served as the principal investigator for landmark trials including FAST-MAG and SWIFT PRIME. Dr. Saver is a former Chair of the AHA Stroke Council, and a recipient of the World Stroke Organization Lifetime Research Award.

Craig Beavers, PharmD, is the Vice President of Operations for Baptist Health Paducah and an Adjunct Associate Professor at the University of Kentucky College of Pharmacy. A board-certified cardiology pharmacist and anticoagulation care provider, he has served as the Cardiovascular Executive Lead for the Baptist Health System and as a director of cardiovascular services for the Hospital Corporation of America. Dr. Beavers is a fellow of the American Heart Association and currently co-chairs the clinical pharmacist workgroup of the American College of Cardiology.

Gerald Beesley – Patient Advocate with the Stroke Buddies.

Continuing Education Information

Commercial support: This activity received monetary support through an independent education grant from Bayer.

This continuing education activity will be provided by AffinityCE and MedAll. This activity will provide continuing education credit for pharmacists.

Disclosures

Jeffrey L. Saver, MD, FAHA, FAAN, FANA has disclosed financial interests or relationships within the past 36 months with the following ineligible companies: Consultant for Abbott, Aeromics, Bayer, Biogen, Boehringer Ingelheim, BrainQ, BrainsGate, CSL Behring, Medtronic USA, Roche, Stream Medical, Johnson & Johnson, MIVI Neuroscience and Occlutech. Stock Options from MindRhythm, Neuronics Medical, Rapid Medical. These disclosures are provided in accordance with ACCME standards to ensure transparency and uphold the integrity of continuing education. Dr. Saver does not intend to reference any unlabeled or unapproved uses of products during the presentation.

Craig Beavers, PharmD has disclosed financial interests or relationships within the past 36 months with the following ineligible companies: Speaker for Bayer. These disclosures are provided in accordance with ACCME standards to ensure transparency and uphold the integrity of continuing education. Dr. Beavers intends to discuss non-FDA uses of drug products and/or devices only in relation to products for which she has no financial relationships. He will disclose to the audience when this discussion takes place.

Gerald Beesley has no relevant financial relationships with ineligible companies to disclose.

These disclosures are made in accordance with ACCME standards to ensure transparency and objectivity in continuing education.

AffinityCE staff, MedAll staff, as well as planners and reviewers, have no relevant financial relationships with ineligible companies to disclose.

Mitigation of Relevant Financial Relationships

AffinityCE adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CME activity, including faculty, planners, reviewers, or others, are required to disclose all relevant financial relationships with ineligible companies. Relevant financial relationships were mitigated by the peer review of content by non-conflicted reviewers prior to the commencement of the program.

Activity Accreditation for Health Professions

Pharmacists

Pharmacists AffinityCE is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education (CPE).

CE Title: Safer Paths Better Outcomes: Advancing Secondary Stroke Prevention Through Factor XIa Innovation - Masterclass

UAN: 0829-9999-26-011-H01-P

Activity Type: Knowledge-based

CEUs: 1

No cost to participate.

Participant CE records will be electronically communicated to CPE Monitor.

Pharmacist Learning Objectives

At the conclusion of this web conference, participants should be able to:

Implement evidence-based antithrombotic strategies for secondary prevention following non-cardioembolic ischemic stroke or TIA, applying current American Heart Association (AHA) and American Stroke Association (ASA) guideline recommendations and insights from contemporary trials such as POINT, CHANCE, and THALES.
Interpret emerging clinical evidence on Factor XIa inhibition - including findings from PACIFIC-STROKE and ongoing Phase III studies such as OCEANIC-STROKE and LIBREXIA-STROKE - to inform treatment decisions in non-cardioembolic stroke.
Coordinate multidisciplinary, pharmacist-inclusive care strategies that reduce the risk of recurrent non-cardioembolic ischemic stroke without compromising safety, ensuring timely initiation, monitoring, and adherence to antithrombotic therapy.

Criteria for Claiming CPE Credit: Participants must have registered and attended the entire program. Attendance is monitored online via time tracking software for participation in the entire activity. Participants must complete the assessment and evaluation. The assessment has a passing score of 80% and may be retaken. US-based participants claiming pharmacist CE credits will need to supply their date of birth and NABP e-Profile ID. Pharmacist CE records will be electronically communicated to CPE Monitor.

How to Earn Pharmacist CE Credit

Registration for the activity does not establish an account in the CE Center or automatically provide continuing education credit. You must sign into the CE Center site and evaluate the content of the activity to earn CE credit.

Please use the private evaluation link provided to you to access the CE Center and select the activity. Links are issued only after the successful completion of the program which includes viewing the entire content and completing the post-activity assessment. The assessment has a passing score of 80% and may be retaken.
Enter your e-mail address and desired password to begin setting up your profile. If you previously established an account but can’t log in, click “I Forgot My Password” or “Help Me Find My Account” for help.
Verify, correct, or add your demographic information and select your profession. Click Continue.
Proceed to complete the activity evaluation. After completing the evaluation, you will be able to download your CE certificate. Your CE record will also be stored here for later retrieval.
US-based participants claiming pharmacist CE credits will need to supply their date of birth and NABP e-Profile ID. Pharmacy CE records will be electronically communicated to CPE Monitor.
The website is open for completing evaluations until December 31, 2026.
After the website has closed, you can come back to the site at any time to download your certificate, but you will not be able to add any evaluations.

Please send any CME policy-related or customer service requests to cds_support+medall@affinityced.com.

System Requirements

Mobile device (e.g., large-format smart phone; laptop or tablet computer) or desktop computer with a video display of at least 1024 × 768 pixels at 24-bit color depth, capable of connecting to the Internet at broadband or faster speeds, with a current version Internet browser and popular document viewing software (e.g., Microsoft Office, PDF viewer, image viewer) installed. Support for streaming or downloadable audio-visual materials (e.g., streaming MP4, MP3 audio) in hardware and software may be required to view, review, or participate in portions of the program.

Unapproved and/or off-label use disclosure

AffinityCE/MedAll requires CE faculty to disclose to the participants:

When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and
Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.

Participation Costs

There is no cost to participate in this program.

This continuing education activity is active starting February 27th 2026 and will expire on December 31st 2026.

Estimated time to complete this activity: 75 minutes.

Learning objectives

Implement evidence-based antithrombotic strategies for secondary prevention following non-cardioembolic ischemic stroke or TIA, applying current American Heart Association (AHA) and American Stroke Association (ASA) guideline recommendations and insights from contemporary trials such as POINT, CHANCE, and THALES.
Interpret emerging clinical evidence on Factor XIa inhibition - including findings from PACIFIC-STROKE and ongoing Phase III studies such as OCEANIC-STROKE and LIBREXIA-STROKE - to inform treatment decisions in non-cardioembolic stroke.
Coordinate multidisciplinary, pharmacist-inclusive care strategies that reduce the risk of recurrent non-cardioembolic ischemic stroke without compromising safety, ensuring timely initiation, monitoring, and adherence to antithrombotic therapy.

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, everyone. I'm Doctor Jeffrey Saber, a professor of neurology at UCLA and I'll be talking in this brief program about applying evidence-based antithrombotic strategies for secondary stroke prevention. Here are my disclosures. The objective of this presentation is to help you implement evidence-based antithrombotic strategies for secondary prevention following non-cardimbolic ischemic stroke or TIA as outlined in the recently issued American Heart Association guideline recommendations, and with additional insights from contemporary trials. To motivate things, let's start off with a polling question. In patients with minor non-cardibolic ischemic stroke or high-risk TIA who present within 24 hours and have no contraindications, which antithrombotic strategy would you recommend to reduce early recurrent stroke risk? And you can see the five strategies below that are kind of wordy, so I'll let you read through them and give you a chance to give an answer. All right. Now, let's go ahead and we'll cover the material that provides the answer for that in a case-based way. We're gonna have 3 motivating cases today. This is the first Ms. Jones, who's a 68 Caucasian woman who presented with right-sided numbness affecting the face, arm, And leg and no other deficits. Uh, and that stroke scale was 2. She does have a background medical history of hypertension, hyperlipidemia, and diabetes. And she was on no antithrombiotics prior to presenting with this stroke. And you can see on the MRI scan, on the right, the DWI shows a Abnormality in the ventral postolateral portion of the thalamus where a pure sensory stroke will occur from a small lacunar infarct. Diagnostic workup in Ms. Jones followed the usual workup for causes in ischemic stroke patients by imaging the blood vessels in the aorta, head, and neck. Doing coagulation labs for the clotting system, looking for structural cardiac disease with echocardiography, and looking for cardiac dysrhythmias with cardiac telemetry. And in Ms. Jones, Three of these were completely normal. There was some left ventricular hypertrophy seen on her echo consistent with her hypertension, but that is not a cause of stroke directly. So, um, the, uh, this suggests that she had a true lacunar stroke due to intrinsic occlusions in small vessels from micro atherosclerosis or lipohadeosis too small to see. So What should be done for the antithrombotic therapy in this patient. And the new guidelines from the AHA recommend double antiplatelet therapy or DAPT for 21 days, and then single antiplatelet therapy thereafter or SAPT. When the patient presents with a minor ischemic stroke, as here, and a stroke scale less than 3, that is non-cardiembolic. Or a non-cardibolic high-risk TIA and they've not received intravenous thrombolysis. Uh, in, uh, these patients at lower risk for hemorrhagic transformation and high risk for ischemic stroke, starting with uh double antiplatelet therapy for the first high-risk 21 days is recommended. And stronger evidence exists for the combination of aspirin and clopidogrel. Uh, Uh, a, as a first-line option, aspirin and ticagrelor is also recognized as a first-line option, but may have a little bit more complications, so it does not have a strong a recommendation. Why are we using antiplatelet agents in this setting for non-carbolic stroke? And the classic view is shown here that uh in patients with atherosclerotic intrusions into the lumen, as in the top, uh, that causes this laminar high-speed flow over the irregular surface of the atherosclerotic plaque. Precipitating platelet activation and aggregation and platelet-rich thrombite. Uh, for those, antiplatelet therapy is preferred. In contrast, for cardiomembolic stroke, most forms, uh, such as atrial fibrillation, it due to stasis in the atrium, low flow, and whenever blood isn't flowing, it tends to clot through the coagulation system, forming red clots, erythrocyte rich. Um, and there where the clotting protein cascade is the driver anticoagulant mech uh, Anticoagulant medications are preferred. In thinking about the antiplatelet agents for patients with non-carbolic stroke, here is a schema of the platelet showing the site of action of our major classes, uh, aspirin, the COX-1 inhibitor, uh, Clopidogrel, ticagrelor, and others as uh PGY2 inhibitors, the GP2-3 blockers, and phosphodiesterase inhibitors. Now, where does the 21 day recommendation for intensive depth come from? It's driven in part by the fact that under standard therapy in patients with non-cardimolic stroke, the risk of recurrence is very front-loaded, as you see here. It is tremendously high in the 1st 3 weeks, still somewhat high between 3 weeks and 3 months, and then medium ongoing risk thereafter. So, uh, the trials that looked at, uh, clopidogrel and aspirin versus aspirin alone, DPT versus single aspirin were the chance and point trials. And here, you can see uh that the patients who had clopidogrel and aspirin were less likely to have a stroke than aspirin alone. And Essentially, all of the benefit of the double therapy occurred in the 1st 3 weeks. If we pull the data from these trials, the double antiplatelet therapy reduces the recurrence in the first three weeks from 6.3% to 4.4%. Uh, however, as you see in the graph, after, um, the major ischemic events cluster early, and then, uh, become low, whereas the bleeding episodes and double antiplatelet therapy will increase the bleeding risk over single antiplatelet therapy remains, uh, modestly elevated throughout the time of therapy. So the Benefit in reducing ischemic stroke versus the cost of increasing hemorrhage, clearly worth undertaking in the 1st 3 weeks, and then it's not clearly beneficial, so the switch to single antiplatelet therapy occurs. The guidelines did have this very nice, very detailed algorithm. Uh, I advise people to have it handy. You start with the non-chombolic stroke or TIA, and you see they're under 24 hours, didn't get TPA minor deficit, that puts you to clopidogrel and aspirin for the 1st 21 days for Ms. Jones. OK, let's turn To case two, Mr. Smith, who's a 72-year-old Asian man who presents with isolated right arm weakness, an anti-stroke scale of 3, history of high BP and tobacco use, and was taking aspirin prior to the event. And on the clear MRI to the right, you can see abnormality in the motor strip right at the hand knob, affecting just the arm. The workup in Mr. Smith found a normal echocardiogram, no atrial fibrillation, but two relevant other findings. On the vessel imaging, there was 60% stenosis of the intracranial left internal carotid siphon, um, not in the neck, not operable, but severe afro there, symptomatic.