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Category: Project

Description: The TAILSWITCH study evaluates optimal secondary-prevention regimens in ischemic-stroke patients already receiving anticoagulation at the time of their index event. Promoted by AUSL Romagna and coordinated by Dr. Michele Romoli (Neurology, Cesena), this multicentre study and combines a retrospective phase (1 Jan 2019–31 Dec 2024) with a prospective phase (1 Jan 2025 onwards). Investigators will compare major vascular outcomes—annualized recurrent ischemic stroke, major adverse cardiovascular events (MaCE), major intracranial hemorrhage, non-trivial minor bleeding, etiology-specific stroke recurrence, 90-day modified Rankin Scale, and mortality—across treatment strategies: standard DOAC prescription versus DOAC prescription with plasma-level DOAC monitoring. Inclusion criteria are adults (≥18 years) of either sex with acute ischemic stroke on anticoagulants and access to participating Stroke Units; key exclusions include transient ischemic attacks and life expectancy <6 months for non-stroke reasons. Assuming a 10% absolute difference between highest- and lowest-impact strategies, at least 250 patients per treatment subgroup are required to detect significant temporal differences at 3–12 months. Data will be pseudo-anonymized, aggregated for analysis, and collected under informed consent. The anticipated duration is 12–24 months for complete data accrual and evaluation, with interim analysis and cluster-center experience expected to define feasibility of the policy-implementation.