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

General Practice

Pharmaceutical 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.

Credits: AMA PRA Category 1 Credits™ (1.00.00 hours)

Type of activity: Enduring material (On-demand)

Launch date: 9 July 2026

Expiration date: 31 December 2026

Estimated time to complete this activity: 60 minutes

Join leading stroke prevention experts Christian Ruff, MD, Mike Sharma, MD and Kori Leblanc, PharmD in this Roundtable, and explore the evolving landscape of secondary stroke prevention. The discussion will focus on integrating guideline-directed antithrombotic strategies, interpreting new Factor XIa inhibitor data, and strengthening multidisciplinary collaboration in real-world settings.

Participants will gain insights into the evolving landscape of secondary stroke prevention, integrating guideline-directed antithrombotic strategies, interpreting new Factor XIa inhibitor data, and strengthening multidisciplinary collaboration in real-world settings.

Prefer to read instead? Read our Key Clinical Summary here.

Session Highlights

Implementation of Guideline-Directed Strategies: Examine evidence-based frameworks for integrating current antithrombotic guidelines into clinical practice.
Evaluation of Emerging Antithrombotic Evidence: Analyze the clinical implications of recent Factor XIa inhibitor data and the logistical requirements for integrating these findings into evolving secondary stroke prevention protocols.
Advancing Multidisciplinary Clinical Synergy: Explore the collaborative models between neurology, pharmacy, and cardiology to streamline clinical decision-making and improve outcomes in real-world settings.

Who Should Participate

This program is designed for healthcare professionals who lead medication management, counseling, and safety monitoring in secondary stroke prevention.

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

Faculty

Christian T. Ruff, MD, MPH is the Director of General Cardiology in the Cardiovascular Division at Brigham and Women’s Hospital in Boston, MA and an Associate Professor of Medicine at Harvard Medical School. Dr Ruff is a Senior Investigator in the Thrombolysis in Myocardial Infarction (TIMI) Study Group and serves the Director of the Genetics Core Laboratory and the Co-Chairman of the Clinical Events Committee. He has led a broad array of projects, ranging from investigator initiated studies of biomarkers and genetic variants to large clinical trials. Dr Ruff has served on international clinical guideline committees and has been invited to give hundreds of lectures nationally and internationally. He has authored many scholarly articles, editorials, reviews, and book chapters that include the New England Journal of Medicine, Lancet, Journal of the American Medical Association, American Journal of Medicine, Circulation, Journal of the American College of Cardiology, and Nature Reviews Cardiology.

Mike Sharma, MD is Professor of Medicine (Neurology) at McMaster University and a vascular neurologist at Hamilton Health Sciences. He holds the Michael G DeGroote Chair in Stroke Prevention and leads the Brain Health and Stroke Program at PHRI. He is the Medical Director of the Regional Stroke Program at HHS. Dr Sharma is the Past Chair of the Canadian Stroke Consortium and was the Deputy Director of Clinical Affairs and Policy at the Canadian Stroke Network. He has held leadership positions in trials of novel antithrombotic approaches to stroke prevention and imaging/cognitive outcomes in large trials of stroke prevention.

Kori Leblanc, PharmD is a Cardiovascular Pharmacotherapy Specialist in the Department of Pharmacy Services and a Clinician Investigator at the Toronto General Hospital Research Institute at the University Health Network. She is also an assistant Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto. She is a past Primary panel member of the Canadian Cardiovascular Society Atrial Fibrillation and Heart Failure guidelines. Her practice expertise and interests include, atrial fibrillation, thrombosis, and anticoagulation in pharmacy practice.

Continuing Education Information

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 physicians. A statement of participation is available to other attendees.

Faculty Disclosure Statement

Christian T. Ruff, MD Christian T. Ruff, MD has disclosed financial relationships within the past 24 months with the following ineligible companies: Grant through his institution from Anthos, AstraZeneca, Daiichi Sankyo, Janssen, and Novartis; Honoraria for participation on scientific advisory boards and consulting from ADARx, Bayer, Novartis, Sirius, Souffle. Dr Ruff does not intend to reference any unlabeled or unapproved uses of products during the presentation.

Mike Sharma, MD: Mike Sharma, MD has disclosed financial interests or relationships within the past 24 months with the following ineligible companies: Consultant for Anthos Therapeutics, AstraZeneca, Bayer, Janssen Global Services, Novartis, Regeneron, Grant/Research Support (to institution) from AstraZeneca, Bayer, Bristol Myers Squibb, End-point Review Committee for Articure Inc. Dr Sharma intends to discuss non-FDA uses of drug products and/or devices only in relation to products for which he has no financial relationships. He will disclose to the audience when this discussion takes place.

Kori Leblanc, PharmD has disclosed financial relationships within the past 24 months with the following ineligible companies: Consultant for Bayer, Advisory Board Member for Anthos. Dr. Leblanc intends to discuss non-FDA uses of drug products and/or devices only in relation to products for which he has no financial relationships. She will disclose to the audience when this discussion takes place.

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. All relevant financial relationships for anyone associated with the content of this activity were mitigated prior to the release of this program.

Activity Accreditation for Health Professions

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credits™. Physician assistants should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioners

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credits™. Nurse practitioners should claim only the credit commensurate with the extent of their participation in the activity.

Nurses & Other Professionals

All other health care professionals completing this continuing education activity will be issued a statement of participation indicating the number of hours of continuing education credit. This may be used for professional education CE credit. Please consult your accrediting organization or licensing board for their acceptance of this CE activity.

Pharmacists

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

Activity Type: Knowledge

UAN: 0829-9999-26-110-H01-P

Release Date: 07/15/2026 Expiration Date: 12/31/2026

Activity Length: 60 minutes

Contact Hours: 1

Cost to participate: None

Participant CE records will be electronically communicated to CPE Monitor.

Pharmacist Learning Objectives:

At the completion of this activity, the participant will be able to:

Implement evidence-based antithrombotic strategies for secondary prevention following non-cardioembolic ischemic stroke or TIA, applying current AHA/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.

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.

CME Inquiries

For all CME policy-related inquiries, please contact us at ce@affinityced.com.

Participation Costs

There is no cost to participate in this program.

To Earn CME Credit

1. Review the program materials

2. Click the green button on the right to "Claim CME credit"

3. Complete the Post-Test; this test features real-time learning. You will receive immediate feedback and rationales explaining the correct answers as you go. The requirement is 70% accuracy.

4. Once you have successfully passed the test and completed the required CME evaluation, your certificate will be available for download and emailed to you.

Disclaimer

This activity is intended for educational purposes only and does not establish a standard of care or replace clinical judgment. Any therapeutic or diagnostic strategies discussed must be evaluated in the context of each patient’s clinical circumstances, risks, and current evidence.

Learners should consult authoritative clinical guidelines and approved product information when considering treatment decisions.

All materials are used with permission. The views expressed are those of the faculty and do not necessarily reflect those of the accredited providers, MedAll, or any supporters.

Content is accurate as of the date of release.

Learning objectives

Implement evidence-based antithrombotic strategies for secondary prevention following non-cardioembolic ischemic stroke or TIA, applying current AHA/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

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

Hello and welcome to today's CME accredited roundtable on evolving strategies in secondary stroke prevention. I'm Mike Sharma. I am a stroke neurologist and director of the stroke Program at Hamilton Health Sciences. I'm a professor of medicine at McMaster University where I hold the Michael G. Duroot Chair in Stroke Prevention. Before we begin, we'll display faculty disclosures on screen in accordance with the accreditation requirements. Now, stroke remains a leading cause of death and disability, and despite advances in care, including hyper acute treatments, up to 10 to 17% of our patients experience a recurrent event within the first year. This highlights persistent gaps in how we implement the strategies that we currently have, and also how we're going to integrate emerging therapies and coordinate care across disciplines. I'm delighted today to be joined by two truly outstanding colleagues. Doctor Christian Ruff is the director of cardiovascular medicine, clinical operations at Mass General Brigham Heart and Vascular Institute, a senior investigator in the Timmy Study Group, and associate professor of medicine at Harvard Medical School. Welcome, Doctor Ruff. Thank you, man. And Doctor Corey Leblanc is a pharmacotherapy specialist at the University Health Network, a clinical investigator at the Toronto General Research Institute, and an assistant professor at the University of Toronto. Welcome, Corey. Thanks so much for being, for allowing me to be here. Thank you both for joining us today. In the discussion, we're gonna focus on three key areas. The first is optimizing antithrombotic strategies early after stroke. We actually don't use efficiently and effectively what we already have. The second part will be interpreting the emerging and if I may say exciting evidence for factor 11A inhibition and stroke prevention. And the third, which I think is critical, is strengthening multidisciplinary, multidisciplinary care, particularly the role of pharmacists. So let's begin. We'll start by focusing on the earliest and most critical decisions we make after a stroke or TIA, particularly how we optimize anti-thermotic strategies in that high risk initial period. So Doctor Ruff, in patients with minor non-cardimbolic stroke or higher STIA, how do you approach antithrombotic selection in the 1st 24 hours, and what are the key decision points that determine whether you escalate to dual antiplatelet therapy? Yeah, thank you. So great to be with you again. Obviously, a lot of this I've learned from the wonderful work that you've done. Many other leading, uh, stroke neurologists in the field. And I think, you know, the key point I've certainly learned as a cardiologist sharing, you know, many of these patients. And it's very sort of similar to how we manage actually patients after any acute thrombotic event in the brain or the heart is the risk of recurrent event is really front loaded. Um, and with respect to stroke, you know, we know this from kind of landmark clinical trials. Such as chance and point and looking at kind of all the data that we have is that the risk is high, um, particularly in the first week and, and really extending out, um, to 21 days. Uh, and so it's really in those first couple of weeks where in patients who've had a minor stroke or high-risk TAIA they're most at risk for having another stroke. And so we really wanna protect patients early. Now, obviously, to do that, a cornerstone of therapy, as you noted. Is antiplatelet therapy and particularly in patients where we want to reduce this high risk of recurrence. Dual antiplatelet therapy or two antiplatelet agents, normally aspirin plus a P2Y12 inhibitor such as clopidogrel, and the trade-off is the same trade-off we always struggle with antithrombotic therapy, weighing the risk of a recurrent ischemic events with the risk of bleeding. Now, the risk of bleeding is continuous and so you start a more intensive regimen and your risk of bleeding is just continuous. Um, and so it's really trying to weigh like when is the risk of a recurrent ischemic event high enough to warrant that, that extra bleeding risk. And so it's certainly in these, you know, minor stroke, high-risk TIA because that stroke risk is really high in those first couple of weeks, particularly out to 21 days from the data, that that makes sense as an opportunity to intensify therapy, to dual antiplatelet therapy for. That period of time, but then after that, you really kind of shift and as the recurrent stroke rate goes down, they have this continued bleeding risk, you know, certainly in, in many patients that risk benefit no longer supports D and at that point, you know, de-escalating therapy to kind of long-term secondary protection and single antiplatelet therapy makes sense. And so that's why in the guidelines and. Guidance documents you'll see in these types of patients should be thinking about potentially escalating to dual antiplatelet therapy, particularly for those 1st 21 days in appropriate patients, and then, um, after that where the bleeding risk is really too high for most patients for continuous uh depth, uh, to continue to step down. So, I, I think excellent points. Um, how would you characterize a selection of patients? So we think about non-cardibolic, ischemic stroke, high risk TIA, what kind of patients in that group should be treated with that, or conversely, who would you not treat with that? Yeah, it's a great question. So obviously, you know, because that, we're always weighing like what is the side effect of the therapy we're giving here and obviously the risk of bleeding. And so we wanna be very careful to select patients where their risk of bleeding is not higher than would be appropriate. So certainly patients who have. Experienced significant bleeding before, I'd often be cautious about that. We know adding another antiplatelet agent on top of a single one increases the bleeding, uh, usually almost doubles it. And so patients who've experienced prior bleeding. Obviously, the bleeding we're most worried about is bleeding in the brain. And so that's why we're really focusing on these minor strokes because we know as the strokes get. More severe, the risk of hemorrhagic transformation from that ischemic stroke transitioning to bleeding in the brain is higher. So, as you said, we're sort of picking these patients that have high risk of ischemic event, low risk of bleeding in the brain, particularly hemorrhagic transformation, and in general, are, are we think relatively low risk of bleeding. So a patient who has like recurrent GI bleeds that bled before on. Say for some reason, that probably wouldn't be um a patient that you would, you would want to treat for several weeks of that. And so I think it's trying to find the sweet spot where uh it's not a very large dense stroke where you're cautious about intracranial hemorrhage in a patient who has what you believe to be a reasonable risk of, of a low, low risk of bleeding. Thanks very much. I think that clarifies things a lot, and we do have to remember that the dual antiplatelet trials excluded patients who had hyper acute treatment, so patients who were, yeah, and had mechanical clot retrieval. Well, let's see what the audience thinks in this scenario. So we'll put up the polling question, this is question number 1, and the question is, in patients with minor non-cardiombolic stroke presenting within 24 hours, what is the most appropriate initial strategies, strategy, and there are the options available, please do select an option. Thank you very much for participating in that poll, and we're gonna continue. I'll address the next question to Doctor Leblanc. So, Doctor Leblanc, we've talked about selecting the right antithrombotic strategy early on. How does this translate at the point of discharge from a pharmacist's perspective? What are the key considerations to ensure patients are started on the right regimen and can actually adhere to it in those first critical weeks? Right, so, in addition to all the uh comments that Doctor Ruff made about selection and of patients uh for these therapies, I think I might uh include uh drug interactions. So, from the pharmacist lens, of course, um, there are some um considerations with uh clopidogrel being uh requiring, um, Cytochrome P450 enzymes to uh become activated to actually do its job. And on the ticagrelor side, um, it's the reverse. So, uh, ticagrelor requires cytochrome P450 for metabolism. So, it's rare, um, these, uh, strong inhibitors or strong inducers of cytochrome P450 enzymes are, uh, not that common, um, but they're important. And so, you know, as, um, as the pharmacist starts to look at this acute stroke patient, that will be one of the screening, um, um, considerations for determining that this is the, indeed the right thing for this patient. From the discharge side or the transition. So, one important thing I think we all know on this, uh, on this, um, call is that transitions of care are the, have the greatest risk for things happening that we really don't intend to have happen. Um, and so, you know, uh, the stroke patient.